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ESSENTIALS  OF  ORTHODONTIA 
D A  LTO  N 


ESSENTIALS  OF  ORTHODONTIA 


WITH  ESPECIAL  REFERENCE  TO  NOMENCLATURE  INCLUD- 
ING AN  OUTLINED  COURSE  IN  PRACTICAL 
TECHNICS  FOR  STUDENTS 


BY 

VAN  BROADUS  DALTON,  D.D.S. 

PROFESSOR  OF   ORTHODONTIA,  EXODONTIA  AND  ANAESTHETICS,  OHIO  COLLEGE   OF   DENTAL 

surgery;  member  of   THE  AMERICAN  SOCIETY  OF    ORTHODONTISTS;  MEMBER  OF 

THE  NATIONAL  DENTAL  ASSOCIATION;  MEMBER  OF  THE  OHIO  STATE  DENTAL 

SOCIETY;   MEMBER   OF  THE    CINCINNATI  DENTAL  SOCIETY;  MEMBER 

OF  THE  CINCINNATI  DENTAL  RESEARCH     SOCIETY 


^'1.  Z  i 


WITH  167  ILLUSTRATIONS 


PHILADELPHIA 
BLAKISTON'S  SON   &   CO. 

1012  WALNUT  STREET 


j)n 


Copyright,  1914,  by  P.  Blakiston's  Son  &  Co. 


THE. MAPLE . PRESS. YORK. PA 


PREFACE 

This  book  is  intended  to  fill  a  need  for  a  work  that  shall 
contain  only  the  essentials  of  orthodontia.  It  is  not  meant 
to  displace  or  supersede  any  modern  text-book  on  this  impor- 
tant subject,  but  rather  to  be  an  aid  and  incentive  to  deeper 
study  and  research  in  this  branch  of  dental  science. 

Up  to  a  few  years  ago  orthodontic  terminology  was  quite 
inadequate,  but  now  there  seems  to  be  a  sufficiency  of  terms, 
by  the  aid  of  which  one  is  able  to  describe  any  case  of  mal- 
occlusion. 

In  the  writer's  opinion,  far  more  good  can  be  accomplished 
by  adhering  to  one  good  classification  than  by  presenting  to 
the  student  an  assemblage  of  classifications  by  different 
authors,  consequently  he  has  given  preference  to  the  x\ngle 
Classification  which  appears  to  be  the  only  one  that  is  based 
upon  a  really  firm  foundation,  although,  at  least  one  other, 
namely,  that  of  Lischer's,  has  received  recognition  of  late. 

In  preparing  the  first  chapter,  which  deals  solely  with 
nomenclature,  the  author  has  freely  culled  from  the  various 
text-books  and  writings  on  the  subject.  Immediately  follow- 
ing this  chapter  comes  that  on  occlusion,  and  it  is  to  be  earn- 
estly hoped  that  the  student  will  thoroughly  acquaint  himself 
with  the  relations  of  each  individual  tooth  in  normal  occlusion. 
Until  he  so  does  he  can  never  thoroughly  comprehend  mal- 
occlusion nor  understand  the  classifications. 

Verification  of  the  student's  thoroughness  in  the  study  of 
occlusion  can  be  had  by  referring  to  the  chart  diagram  on 
occlusion,  which  is  to  be  used  during  the  quiz  on  this  chapter. 

During  the  past  seven  years  the  author  has  made  an 


VI  PREFACE 


especial  study  of  causal  factors  entering  into  the  production 
of  malocclusion  and  he  believes  that  the  personal  conjectures 
and  purely  hypothetical  causes  mentioned  by  some  authors 
deserve  no  notice  as  etiological  factors,  and  wishes  to  call 
especial  attention  to  the  discovery  of  what  he  believes  to  be 
the  cause,  at  least  in  the  great  majority  of  cases,  of  open-bite 
malocclusion. 

The  author  hopes  that  he  has  accomplished  his  long  cher- 
ished aim  to  present  a  book  wherein  the  terminology  and 
classification  have  been  so  grouped  and  indexed  that  the 
student  can  readily  find  the  meaning  of  a  certain  term  with- 
out having  to  read  several  pages. 

Following  are  the  text-books  and  writings  freely  consulted 
in  the  preparation  of  this  work : 

Angle:  Malocclusion  of  the  Teeth,  Seventh  Edition. 

Lischer:  Principles  and  Methods  of  Orthodontics. 

Lischer:  Elements  of  Orthodontia. 

Case:  Dental  Orthopedia. 

Guilford:  Orthodontia  or  Malposition  of  the  Human 
Teeth;  Its  Prevention  and  Remedy,  Fourth  Edition. 

JoHXSOX:  Operative  Dentistry,  Second  Edition  (Chapter 
by  Pullen). 

Transactions  of  the  National  Dental  Association. 

Reports  of  the  Committee  on  Nomenclature  American 
Institute  of  Dental  Teachers. 

V.  B.  D ALTON. 

CiNCTNXATi,  Ohio. 


CONTENTS 

CHAPTER  I 

Nomenclature 

Page 

The  Various  Terms  and  Principles  of  Application  Defined i 

CHAPTER  II 
Occlusion 

The  Importance  of  the  Study  of  Occlusion 14 

The  Basis  of  the  Science  of  Orthodontia 15 

Object  of  Occlusion 15 

The  Arrangement  of  the  Teeth 15 

The  Deciduous  Teeth 16 

Importance  of  the  First  Permanent  Molars      17 

Neglect  of  the  First  Permanent  Molars i? 

Relation  of  the  Permanent  Teeth  in  Normal  Occlusion 18 

Angle's  Classification 18 

CHAPTER  III 

Etiology 

The  Causes  of  Malocclusion 21 

The  Cause  df  Open-bite  Malocclusion 23 

CHAPTER  IV 

Facial  Art 

Relation  of  Facial  Art  to  Normal  Occlusion 32 

Use  of  the  Clay  Model  of  the  Face 32 

CHAPTER  V 
Impression  and  Model  Making 

Use  of  Modeling  Compound 38 

Use  of  Plaster  of  Paris 39 

Importance  of  Good  Models 4i 

Method  of  Trimming   the  Model 42 

Cabinet  for  Models 43 

Securing  of  Models  Prior  to  Retention      43 

vii 


V11I 

CONTEXTS 


CHAPTER  VI 


Band  :\Iakixg  and  Solderixg 
Advantages  of  the  Plain  Band 

Method  of  Making  Plain  Bands.    ...'.. ^^ 

Manner  of  Separating  Teeth '^^ 

Use  of  Gold  and  Gold  and  Platinum  Plate  "^^ 

The  Adjustable  Clamp  Bands 47 

Soldering 47 

Importance  of  Cleanliness  in  Soldering ^8 

Soft  Soldering     ....  48 

Treatment  of  Cases 48 

Application  of  the  Expansion  Arch  in  Fractures "^^ 

Conditions  which  Require  the  Services  of  the  Dentist "^^ 

Harmful  Effects  Due  to  Extraction ^^ 

Ligating  Loose  Teeth  in  Accidents.  ^^ 

54 

CHAPTER  VII 

Methods  and  Applianxes 
Usefulness  of  the  Expansion  Arch  .... 

The  Seven  Possible  Tooth  :\Iovements ■^^ 

The  Nine  Possible  Malpositions  57 

Importance  of  Correct  Alignment  of  the  Expansion  \rch '^ 

Proper  Alignment  of  Sheath  or  Tube  on  Anchor  Bands         ? 

Method  of  Tightening  the  Ligatures      ...  ^° 

The  New  Angle  Appliance ^° 

Description  of  Practical  Cases  Treated ^^ 

63 

CHAPTER  VIII 

Retextiox 

Time  Required  for  Retention. 

Preservation  of  Retainers  after  Removal 77 

Different  Methods  of  Retention  Illustrated  '^^ 

Technic  Course 78 

Materials  and  Instruments  ...  '8 


ESSENTIALS  OF  ORTHODONTIA 

CHAPTER  I 
TERMINOLOGY 

Orthodontia. — The  word  is  of  Greek  origin  and  means 
straight  tooth.  It  is  defined  by  Dr.  Angle  as  "that  science 
which  has  for  its  object  the  correction  of  malocclusion  of  the 
teeth."  It  is  also  defined  by  Dr.  PuUen  as  "that  science 
which  treats  of  the  etiology,  diagnosis  and  correction  of  oral 
and  facial  deformities,  resulting  from  dental  malocclusion  or 
from  abnormality  of  contiguous  tissues." 

Orthodontics. — This  term  was  proposed  by  Sir  James 
Murray,  arid  advocated  by  Dr.  Lischer  and  others  and  defined 
by  Lischer  as  "that  branch  of  dentistry  which  deals  with  the 
principles  and  practices  involved  in  the  prevention  and  correc- 
tion of  malocclusion  of  the  teeth,  and  such  other  malformations 
and  abnormalities  as  may  be  associated  therewith."  Dr. 
Frederick  B.  Noyes  defines  it  as  "the  study  of  the  relation  of 
the  teeth  to  the  development  of  the  face,  and  the  correction 
of  arrested  and  perverted  development." 

Dental  Orthopedia. — The  word  "orthopedia"  is  also  of 
Greek  origin  and  means  "straight  child."  It  is  applied  to 
that  branch  of  surgery  that  straightens  or  adjusts  anatomical 
deformities.  The  term  "dental  orthopedia"  has  been  ad- 
vanced by  Dr.  C.  S.  Case  as  suitably  applicable  to  indicate 
that  specialty  which  deals  with  the  correction  of  dental  and 
facial  deformities  by  orthopedic  movements  of  the  teeth  and 
connecting  bones.  The  term  no  doubt  is  a  very  good  one 
but  it  will  never  displace  the  term  "orthodontia."  The 
meaning  of  the  word  "orthodontia"  when  literally  translated 
is  a  little  misleading  from  the  fact  that  we  do  not  straighten  or 


2  ESSENTIALS    OF    ORTHODONTIA 

correct  the  shape  of  an  individual  tooth,  but  simply  correct  the 
position  of  the  teeth. 

Dento-facial  orthopedia,  as  the  word  implies,  refers  to 
the  correction  of  irregularities  of  the  teeth  and  related  facial 
bones.  It  is  defined  by  Pullen  as  "  that  art  which  deals  with 
the  restoration  of  facial  symmetry,  through  the  prevention 
and  treatment  of  abnormal  development  of  dental  and 
maxillary  arches." 

Dento-facial  area  is  the  facial  area  which  is  supported 
and  characterized  by  the  teeth  and  the  alveolar  process. 

Dento-facial  relation  refers  to  the  relation  which  the 
teeth  in  occlusion  bear  to  the  physiognomy.  "In  normal 
dento-facial  relations,  or  dento-facial  harmony,  the  teeth  and 
overlying  features  are  in  the  most  perfect  harmony  to  the 
general  facial  outlines." 

Naso-labial  folds,  depressions,  or  lines  extend  from  the 
lateral  borders  of  the  wings  of  the  nqse  diagonally  downward 
to  a  point  slightly  below  the  corners  of  the  mouth,  marked  by 
the  action  of  the  orbicularis  oris  and  risorius  muscles. 

Irregularity. — The  terms  "irregular"  and  "irregularity," 
when  used  in  reference  to  the  position  of  the  teeth,  mean  that 
the  said  teeth  are  not  in  the  regular  or  established  anatomical 
relations.  Teeth  are  irregular  when  they  are  (i)  not  in  normal 
alignment;  (2)  not  in  normal  occlusion;  and  (3)  not  in  dento- 
facial  harmony. 

Posed  and  Malposed.— Teeth  are  normally  posed  when 
they  are  regular  or  in  norma)  positions.  The  term  "mal- 
posed"  and  "malposition"  are  used  with  varying  shades  of 
distinction  as  synonymous  with  irregular  and  irjregularity. 

Alignment  and  Malalignment. — Teeth  are  in  alignment 
when  they  are  in  proper  relation  to  the  line  of  their  dental 
arch.  A  tooth  or  teeth  in  malalignment  constitute  an 
irregularity. 


TERMINOLOGY  3 

Occlusal  relation  refers  to  the  relation  in  position  which 
the  upper  and  lower  teeth  bear  to  each  other. 

Normal  occlusion,  typical  occlusion  and  normal  dental 
relations  refer  to  the  established  anatomical  or  standard 
occlusion.  The  word  '^normal"  means  "according  to  rule" 
or  "that  which  is  in  conformity  to  natural  law." 

Interdigitate  and  interdigitation  have  reference  to  any 
closure  of  the  buccal  teeth  in  which  the  cusps  of  one  denture 
strike  fairly  into  the  occluding  sulci  of  the  other,  as  opposed 
to  that  which  is  sometimes  called  an  "end-to-end  occlusion." 
When  the  teeth  are  in  normal  occlusion  the  buccal  cusps  are 
in  normal  interdigitation. 

Malinterdigitation. — When  the  buccal  cusps  fairly  inter- 
digitate with  the  teeth  in  abnormal  occlusion,  as  in  upper 
protrusions,  for  mstance,  where  the  upper  buccal  cusps  are 
fully  the  width  of  a  bicuspid  mesial  to  a  normal  occlusion  with 
the  lower,  the  cusps  are  in  abnormal  interdigitation  or 
* '  malinterdigitation. ' ' 

See  Dental  Orthopedia.  p.  8. 

Open-bite  Malocclusion. — When  upon  occlusion  of  the 
posterior  teeth  the  anterior  or  "biting"  teeth  do  not  come 
together,  but  leave  a  space  of  more  or  less  width  between, 
the  irregularity  may  be  properly  termed  an  "open-bite 
malocclusion." 

Close-bite  Malocclusion. — The  contrary  of  the  above 
would,  therefore,  apply  to  those  cases  in.which  a  closure  of 
the  posterior  teeth  causes  the  anterior  teeth  to  pass  their 
normal  occlusal  planes,  frequently  forcing  the  lower  incisors 
deeply  into  the  gum  to  the  lingual  of  the  upper  anterior 
teeth. 

Short-bite  Malocclusion. — When  all  of  the  teeth — both 
posterior  and  anterior — are  too  short  in  relation  to  the  normal 
occlusal  plane,  or  to  a  plane  in  line  with  the  normal  closure 


4  ESSENTIALS    OF    ORTHODONTIA 

of  the  lips,  the  irregularity  is  spoken  of  in  Case's  work  as 
"short-bite  malocclusion."  He  says  further,  "it  is  charac- 
terized by  a  great  redundancy  of  labial  and  buccal  tissue. 

Long-bite  malocclusion  would  be  the  contrary  position, 
with  all  of  the  teeth  too  long  in  relation  to  the  normal  occlusal 
plane,  and  characterized  by  elongated  features,  abnormal 
exposure  of  the  teeth  in  talking,  difhculty  in  closing  the 
lips,  etc. 

Arch. — The  dental  arch  is  that  inscribed  by  the  teeth. 

Arch  malrelation,  where  the  lower  arch  is  mesial  or  distal 
to  normal  in  its  relation  to  the  upper  arch. 

Alveolar  arch  is  that  arch  inscribed  by  the  alveolar 
process  and  overlying  gum. 

Dome. — The  dome  of  the  oral  arch  refers  to  the  roof  of 
the  mouth. 

Maleruption. — Abnormal  eruption  of  teeth,  resulting  in 
malposition. 

Maltumed  is  used  in  reference  to  a  tooth  so  turned  on  its 
central  axis  as  to  stand  in  malposition.  The  term  "mal- 
turned"  is  sometimes  used  synonymously  with  "torsion" 
and  "torso-occlusion." 

Rotate  is  used  in  reference  to  the  process  of  turning  a 
tooth. 

Zone  is  a  favorable  word  for  locating  sections  of  the 
dental  and  alveolar  arches  that  we  frequently  wish  to  refer  to 
in  describing  different  characters  of  general  malpositions  and 
movements. 

Dental  zones  may  be  considered  as  narrow  areas  extending 
along  the  dental  arch  parallel  to  the  occlusal  plane  as  Occlusal, 
Apical  and  Gingival  Zones. 

Anterior  and  posterior  are  terms  more  commonly  used  to 
define  relative  position  or  movement  in  a  direction  parallel 
to  the  median  line  of  the  dome. 


TERMINOLOGY  5 

Protrusion. — The  incisor  teeth  in  labial  malposition. 

Retrusion. — The  incisor  teeth  in  lingual  malposition. 

Extrude  and  intrude  are  used  to  denote  the  action  of 
correction  of  malposition,  for  instance  in  extrusion,  we  refer 
to  the  act  of  forcibly  erupting  a  tooth,  or  bringing  it  further 
from  its  socket,  while  "intrusion"  refers  to  the  act  of  forcing 
a  tooth  into  its  socket. 

Contrude  is  a  word  used  to  indicate  an  abnormal  lingual 
curve  of  any  portion  of  the  line  of  the  dental  arch. 

Superior  and  inferior  when  used  with  reference  to  the 
teeth,  mean  the  teeth  of  the  upper  and  lower  jaw. 

Unilateral,  indicating  location,  refers  to  one  side. 

Bilateral,  indicating  location,  refers  to  both  sides. 

Unimaxillary,  indicating  location,  refers  to  one  jaw. 

Bimaxillary,  indicating  location,  refers  to  both  jaws. 

Cast. — The  literal  meaning  of  the  term  refers  to  anything 
which  is  made  by  pouring  a  crystallizable  substance  such  as 
plaster  or  fusible  metal  into  an  impression  or  mold. 

See  Dental  Orthopedia,  p.  9. 

Model  is  indicative  of  an  object  which  is  employed, 
modeled,  or  fashioned  as  a  pattern  for  duplication,  although 
the  term  model  has  been  used  extensively  by  writers  in  refer- 
ring to  plaster  casts  of  the  teeth. 

Infra-occlusion,  or  lack  of  occlusion  of  the  teeth,  is  a 
condition  where  the  teeth  of  one  arch  do  not  occlude  with 
those  of  the  opposite  arch.  Infra-occlusion  may  occur  in 
several  different  forms,  being  associated  more  or  less  with  all 
classes  of  malocclusion. 

Infra-occlusion  of  the  Incisors,  Cuspids  and  Bicuspids. — 
The  most  common  form  of  infra-occlusion  is  observed  in  lack 
of  occlusion  of  the  incisors  and  cuspids,  although  the  bicuspids 
may  be  involved,  and  even  the  first  and  second  permanent 
molars  in  rare  cases. 


6  ESSENTIALS    OF    ORTHODONTIA 

Bilateral    Infra-occlusion   of  Bicuspids    and    Molars. — 

Extensive  infra-occlusion  involving  the  bicuspids  and  molars 
on  both  sides. 

Unilateral  Infra -occlusion  of  the  Bicuspids  and  Molars. — 
Lack  of  occlusion  of  the  molars  and  bicuspids  on  one  side  only. 

Bimaxillary  Infra-occlusion. — Lack  of  occlusion  of  all 
the  teeth  in  both  arches.  A  case  of  this  kind  was  described 
by  Dr.  C.  S.  Case,  in  the  Dental  Cosmos,  for  December,  1905, 
page  14 II. 

Mandibular  Retroversion. — Where  the  mandible  is  in  an 
abnormal  distal  position.  Dr.  M.  N.  Federspiel  defines 
Mandibular  Retroversion,  as  pertaining  to  a  distal  shifting 
of  the  mandible  during  the  growth  and  formation  of  the 
temporo-mandibular  articulation.  This  usually  takes  place 
during  the  period  of  eruption  of  the  teeth. 

Mandibular  anteversion  is  a  forward  shifting  of  the 
mandible  during  the  formation  of  the  temporo-mandibular 
articulation  and  is  often  called  mandibular  protrusion 
(Federspiel) . 

Arch  Predetermination. — The  mechanical!}'  and  anatom- 
ically reconstructed  arch  has  been  made  a  possibility  by  the 
application  of  the  laws  of  Bonwill  in  the  synthetic  reproduc- 
tion of  the  normal  arch  for  any  given  case,  as  worked  out 
geometrically  by  Dr.  C.  A.  Hawley,  whose  method  is  fully 
described  by  Pullen  in  Johnsons'  Operative  Dentistry,  second 
edition,  page  561. 

Supra-occlusion. — When  a  tooth  has  erupted  further  from 
its  socket  than  normal,  being  in  a  state  of  extrusion,  the  condi- 
tion is  known  as  supra-occlusion.  Infra-occlusion  and  supra- 
occlusion  are  usually  associated  together,  for  where  there  is 
infra-occlusion  of  the  incisors,  there  is,  as  a  rule,  supra-occlusion 
of  the  molars;  while  the  opposite  does  not  always  prevail. 

Prognathism. — Abnormal  protrusion  of  the  lower   teeth 


TERMINOLOGY 


and  jaw.  Where  there  is  lack  of  de\'elopment  of  the  upper 
jaw,  it  gives  the  lower  jaw  the  appearance  of  abnormal  pro- 
trusion, so  that  what  appears  to  be  a  prominent  lower  jaw 
to  the  casual  observer,  upon  close  study  is  seen  to  be  normal, 
the  mistaken  diagnosis  being  caused  by  the  inharmonious 
relation  of  the  upper  to  the  lower  jaw. 

Open-bite  Malocclusion,  Anterior  Non-occlusion.  — These 
terms  have  been  used  synonymously  with  infra-occlusion, 
although  it  appears  that  infra-occlusion  is  more  often  used  to 
indicate  the  lack  of  occlusion  of  a  single  tooth,  while  open- 
bite  or  non-occlusion  refers  to  the  lack  of  occlusion  of  several 
teeth,  as  for  example,  lack  of  occlusion  of  the  incisors. 

Occlusion. — The  normal  relation  of  the  occlusal  inclined 
planes  of  the  teeth  when  the  jaws  are  closed.  Normal 
occlusion  is  defined  by  Pullen  as  a  condition  of  perfect  rela- 
tionship existing  between  the  normally  formed  and  arranged 
teeth  of  normally  developed  dental  arches  when  in  antagonism, 
the  mandible  being  in  its  farthest  posterior  position,  and  in 
exact  medium  register  with  the  maxilla,  and  both  in  normal 
relationship  with  contiguous  tissues. 

Malocclusion. — The  perversion  of  normal  occlusal  relations 
of  the  teeth.  It  is  defined  by  Pullen  as  any  variation  from  a 
normal  occlusion,  either  in  size,  shape  or  relation  of  dental 
arches,  or  perversion  of  inclined  cusp  planes. 

Key  to  Occlusion. — The  relation  of  the  first  permanent 
molars,  upper  and  lower,  in  normal  occlusion.  The  mesio- 
buccal  cusp  of  the  upper  first  molar  strikes  in  the  groove 
between  the  mesio-buccal  cusp  and  middle-buccal  cusp  of  the 
lower  first  molar.  Any  deviation  will  show  malocclusion  to 
the  extent  of  the  deviation. 

Line  of  Occlusion. — The  line  with  which  in  form  and 
position,  according  to  type,  the  teeth  must  be  in  harmony  if 
in  normal  occlusion  (Angle). 


8  ESSENTIALS    OF    ORTHODONTIA 

Buccal  Occlusion. — A  bicuspid  or  molar  tooth  outside  the 
line  of  occlusion. 

Labial  Occlusion. — An  incisor  or  cuspid  tooth  outside  the 
line  of  occlusion. 

Lingual  Occlusion. — Refers  to  a  tooth  inside  the  line  of 
occlusion. 

Mesial  Occlusion. — When  a  tooth  is  nearer  the  median 
hne  than  normal. 

Distal  Occlusion. — When  a  tooth  is  posterior  to  normal. 

Torso-Occlusion.— A  tooth  turned  on  its  axis. 

Etiology  of  Malposition. — The  causes  which  produce 
malocclusions  of  the  teeth. 

Gothic  Arch. — Another  almost  obsolete  term  which  was 
used  to  distinguish  the  V-shaped  arch,  a  condition  which  is 
sometimes  met  with  in  the  upper  arch. 

Constricted  Arch. — A  term  applied  to  the  upper  arch 
where  the  bicuspids  are  in  lingual  occlusion. 

Saddle-shaped  Arch. — A  term  having  practically  the  same 
meaning  as  constricted  arch. 

Facial  Harmony. — Xormal  and  proportionate  develop- 
ment of  facial  contour,  dependent  upon  the  corresponding 
normal  development  and  growth  of  the  underlying  osseous 
structures  and  sinuses,  together  with  normal  occlusion  of  the 
teeth. 

Physiology  of  Tooth  Movement. — The  physiological 
changes  which  take  place  in  the  movement  of  teeth. 

Anchorage. — The  resistance  selected  as  a  base  from  which 
force  is  to  be  delivered  for  the  movement  of  teeth  (Pullen). 

Litermaxillary  Anchorage. — The  use  of  anchor  teeth  in 
both  arches  to  move  a  tooth  or  teeth  in  one  or  both  arches. 
Litermaxillary  anchorage  is  defined  by  Pullen  as  the  opposing 
of  the  resistance  of  the  teeth  in  one  arch  against  the  resistance 
of  the  teeth  of  the  other  arch,  partially  or  completely,  to  the 


TERMINOLOGY  9 

advantage  of  tooth  movement  in  the  arch  in  which  the  lesser 
resistance  is  estabHshed. 

Occipital  Anchorage. — The  use  of  a  head  gear  or  occipital 
cap  for  the  movement  of  the  teeth  posteriorly.  Occipital  an- 
chorage is  the  resistance  obtained  through  the  use  of  the  top 
and  back  of  the  head,  in  connection  with  the  head  gear  for 
assisting  tooth  movement  or  maxillary  and  mandibular 
movements. 

Simple  anchorage  is  the  obtaining  of  a  sufficient  resistance 
in  one  part  of  the  arch  for  tooth  movement  in  another  part 
of  the  same  arch,  the  anchorage  resistance  being  relatively 
greater  than  that  of  the  teeth  to  be  moved,  although  admitting 
of  some  instability  of  the  anchor  tooth  (Pullen). 

Stationary  Anchorage. — The  use  of  an  appliance  which 
prevents  tipping  of  the  anchor  tooth;  controlled  in  most 
cases  by  long  tubing  or  sheaths  soldered  on  the  anchor  band 
or  if  the  anchor  tooth  should  move  at  all,  it  would  move 
bodily.  Defined  by  Pullen,  Stationary  anchorage  represents 
an  anchorage  which  is  stable  and  unvarying  in  its  resistance 
for  tooth  movement. 

Intramaxillary  Anchorage. — Where  the  resistances  se- 
lected as  anchorage  for  movement  of  malposed  teeth  is  in  the 
same  dental  arch  as  the  teeth  to  be  moved. 

Extramaxillary  Anchorage. — Where  the  resistances  se- 
lected to  move  malposed  teeth  are  outside  the  dental  arches. 
Example,  use  of  the  occipital  cap. 

Primary  Anchorage. — "The  attachment  to  single  molar  or 
bicuspid  teeth,  on  each  side  of  the  arch,  may  be  designated  as 
primary  anchorage"  (Pullen). 

Secondary  Anchorage. — ''hSould  it  be  desired  to  add  the 
resistance  of  other  teeth  in  the  same  arch,  or  in  the  opposite 
arch,  or  the  resistances  from  the  teeth  of  the  opposite  arch, 
the  additional  anchorage  obtained  would  be  designated  as 


lO  ESSENTIALS    OF    ORTHODONTIA 

secondary  anchorage,  and  would  include  any  of  the  other 
forms  of  anchorage"  (Pullen). 

Reinforced  anchorage  is  the  adding  of  the  resistance  of 
teeth  in  the  same  arch  or  opposite  arch,  through  the  use  of 
other  forms  of  anchorage,  as  auxiliaries,  in  combination  with 
the  already  estabhshed  simple  anchorage. 

Reciprocal  anchorage  represents  the  counterbalancing  of 
anchorage  resistance  between  teeth  located  in  different  parts 
of  the  same  arch,  or  in  opposite  arches,  to  the  mutual  advan- 
tage of  tooth  movements  (Pullen). 

Movement  of  Teeth  in  Phalanx. — The  movement  of  two 
or  more  teeth  in  the  same  direction  at  the  same  time. 

Expansion  Arch. — A  metallic  wire  bent  in  conformit}'  to 
the  shape  of  the  dental  arch. 

Alignment  Wire. — A  later  term  designed  to  succeed  the 
term  Kx])ansion  Arch. 

Jack  Screw. — A  threaded  wire  for  mo\'ement  of  teeth 
through   its  ]:»ushing   jiower  controlled   by  a  threaded   nut. 

Retracting  Screw. — An  appliance  practically  the  same  as 
the  jack  screw,  except  it  is  used  to  draw  the  tooth  to  be 
moved  toward  the  anchor  tooth. 

Regulating  appliances  "are  devices  for  exerting  pressure 
upon  malposed  teeth  in  order  to  move  them  into  harmony 
with  the  line  of  occlusion"  (Angle). 

Developmental  Spaces. — Separation  of  the  deciduous  in- 
cisors as  development  progresses,  due  to  an  interstitial  growth 
in  the  alveolar  process  and  maxillae.  ■  These  spaces  are  most 
prominent  just  before  loss  of  the  deciduous  incisors. 

Regional  Development. — In  their  further  growth,  the 
maxillary  arches  do  not  develop  uniformly,  as  might  be 
supposed,  but  in  regions  corresponding  to  the  periods  of 
eruption  of  the  ditlerent  teeth  (Pullen). 


TERMIN()I,()(;V  II 

Preservative  forces  of  arch  integrity  arc: 

(i)  The  interdigitation  of  the  cusps  of  the  teeth. 

(2)  The  reaction  and  dependence  of  one  arch  u])()n  the 
other. 

(3)  The  muscular  innuence  of  the  ]ij)s,   cheeks  and 
tongue,  labially,  buccally  and  hngually. 

Articulation  is  the  relation  between  the  antagonizing 
surfaces  of  the  teeth  of  maxilla  and  mandible  during  the 
lateral  and  protrusive  excursions  of  the  latter,  dependent 
upon  its  universal  articulation  in  the  glenoid  fossa.  There 
are  three  stages  of  articulation,  viz.,  prehension,  at  tr  if  ion 
and  occlusion.  The  first  two  stages  represent  the  mandible 
in  motion;  the  last,  the  mandible  at  rest — the  teeth  being 
closed  (Pullen). 

Distinction  between  Occlusion  and  Articulation.— Occlu- 
sion is  the  passive  phase  of  articulation,  as  c()mj)ared  to  the 
active  phases  of  prehension  and  attrition.  Occlusion  rei)re- 
sents  the  static,  and  articulation  the  dynamic  relation  between 
the  arches  of  the  teeth. 

Facial  symmetry  consists  of  the  normal  and  proportionate 
development  of  facial  contour,  dependent  upon  the  corresi)ond- 
ing  development  and  growth  of  the  underlying  osseous  struc- 
tures and  sinuses. 

Facial  asymmetry  consists  of  the  abnormal  and  dispro- 
portionate development  of  the  contour  of  the  face,  dependent 
upon  a  corresponding  abnormal  develo[)ment  and  growth  of 
the  underlying  osseous  structures  and  sinuses. 

Force-producing  appliances  are  embodied  in  the  principles 
of  the  spring,  the  screw,  the  lever,  the  elasticity  of  rubber, 
and  the  contraction  of  silk  when  moistened. 

Anchor  bands  are  bands  adapted  to  teeth  selected  as  a 
base  from  which  force  is  to  be  directed  in  the  movement  of 


12  ESSENTIALS    OF    ORTHODONTIA 

teeth.  They  may  be  grouped  under  two  di\'isions,  adjustable 
and  non-adjustable.  The  non-adjustable  designs  were  the 
first  to  be  used,  and  they  were  variously  described  as  cribs, 
clasps,  crowns,  and  ferrules. 

The  following  terms  are  those  advocated  by  Dr.  Lischer, 
using  the  ending  version  from  the  (Lat.  verier ce  to  turn;  to 
change  position)  being  prefixed  by  the  various  terms  which 
indicate  conditions  with  scientific  exactness. 

Labioversion  is  a  term  used  to  denote  labially  malposed 
incisors  and  cuspids. 

Buccoversion  denotes  buccal  malpositions  of  the  bicuspids 
and  molars. 

Linguoversion  denotes  lingual  malposition,  lingual  to 
normal. 

Distoversion  denotes  distal  malposition,  distal  to  normal. 

Mesioversion  denotes  mesial  malposition,  mesial  to  normal. 

Torsoversion — a  tooth  rotated  on  its  axis. 

Supraversion  denotes  extrusion. 

Infraversion  denotes  depression  or  intrusion. 

Perversion  denotes  impaction;  impacted  teeth. 

Transversion  denotes  transposition:  transposed  teeth. 

Hyperplastic  Formation  of  Connective  Tissue. — The 
.coalescence  of  previously  inflamed  membranous  surfaces,  re- 
sulting in  a  tough  fibrous  adhesion. 

"Lischer  recognizes  three  conditions,  each  reducible  to 
elementary  divisions,  regardless  of  their  manifold  combina- 
tions. These  are:  (i)  ]Malformation.of  the  Jaws  and  Their 
Processes;  (2)  Malrelation  of  the  Dental  Arches;  (3)  Mal- 
position of  the  Teeth. 

m.\lfor:\iatiox  of  the  jaws 

1 .  M  aero  gnat  hi  sm — over-development. 

2.  Micrognathism — arrested  development. 


TERMINOLOGY  13 

Prefixes:  a.  Mandibular  or  lower. 

b.  Maxillary  or  upper. 

c.  Bimaxillary — when  both  jaws  are  similarly 
aft'ected. 

Suffix :  'Gnathia ' — meaning  jaw. 

M.\LRELATION  OF  THE  ARCHES 

1.  Distodusion — distal  relation  of  lower. 

Unilateral — one  side  only. 
Bilateral — both  sides. 

2.  Mesioclusion — mesial  relation  of  lower. 

Unilateral — one  side  only. 
Bilateral — both  sides. 

3.  Xeiitrodusion — in  neither  direction. 

Neutral  relation  of  lower  to  upper  (Angle's  class  I). 
The  ending  dusion  from  the  Latin  dandere-dausnm 
to  close.  "^ 

1  From  a  consideration  of  certain  Types  of  Dento-facial  Deformity.  By 
M.  N.  Federspiel,  D.  D.  S.,  M.  D.  Read  before  the  American  Society  of  Ortho- 
dontists, Boston,  juh',  iQii. 


CHAPTER  II 
OCCLUSION 

The  importance  of  the  study  of  occlusion  cannot  easily  be 
over-estimated.  It  is  as  essential  to  a  complete  understand- 
ing of  malocclusion  as  is  the  study  of  anatomy  to  a  complete 
understanding  of  any  deviation  caused  by  disease. 

The  pathologist  would  not  be  able  to  diagnose  the  changes 
in  disease  without  first  being  famihar  with  physiology  and 


Fig.  I. — Reproduction  from  a  large  chart  of  occlusion  used  by  the  writer  for 
teaching  the  relation  of  the  teeth  in -normal  occlusion. 

histology.  Therefore,  it  naturally  follows  that  no  one  can 
comprehend  malocclusion  without  first  having  an  accurate 
knowledge  of  normal  occlusion.  No  mere  smattering  idea 
of  the  arrangement  of  the  teeth  will  suffice.  How  many 
readers  can  tell  what  teeth  in  the  upper  arch  oppose  the  lower 

14 


OCCLUSION  15 

second  bicuspid  in  normal  occlusion,  without  referring  to  the 
diagram  of  occlusion?  Fig.  i.  Occlusion  is  the  basis  of  the 
science  of  orthodontia,  for  the  anatomy  of  each  individual 
tooth,  its  arrangement  and  attachment  are  planned  chiefly 
for  the  purpose  of  occlusion  in  order  that  they  may  best 
serve  the  purpose  for  which  they  were  designed;  namely,  the 
preparation  of  the  food  for  the  stomach. 

The  arrangement  of  the  teeth  of  man  constitutes  one  of 
the  most  wonderful  works  of  nature. 

One  should  stop  to  consider  how  beautiful  and  useful 
is  the  arrangement  of  the  teeth  in  occlusion,  where  there  has 
been  no  impediment  in  nature's  plan,  each  tooth  serving  its 
purpose  and  serving  it  well. 

Consider  also  that  in  nature's  plan,  the  arrangement  of 
each  individual  tooth  is  such  as  to  give  the  greatest  possible 
support,  both  singly  and  collectively,  to  each  other.* 

Each  tooth  has  two  opponents  in  occlusion,  except  the 
lower  central  incisors  and  upper  third  molars. 

Next  consider  the  relationship  of  the  low^er  and  upper  first 
permanent  molars. 

Fig.  2  shows  a  negro  skull  with  beautiful  occlusion,  though 
not  exactly  perfect  because  of  slight  protrusion  of  the 
incisors,  which  is  characteristic  of  this  race.  The  interdigita- 
tion  of  the  cusps  of  the  teeth  from  and  including  cuspid  to 
third  molar  is  absolutely  as  normal  and  accurate  as  could  be 
desired. 

Fig.  3  shows  opposite  side  of  the  same  skull.  This  speci- 
men is  from  the  Museum  of  the  Ohio  College  of  Dental 
Surgery. 

In  the  study  of  occlusion  let  us  first  consider  the  arrange- 
ment of  the  temporary  teeth.  Ordinarily,  at  the  age  of  two 
years  all  the  temporary  teeth  are  erupted  and  occlusion  is 
estabhshed.    The  deciduous  teeth  comprise  twenty  in  number. 


l6  ESSENTIALS    OF    ORTHODONTIA 

These  teeth  erupt  far  more  harmoniously  than  their  permanent 
successors,  due  undoubtedly  to  the  fact  that  there  is  little,  if 
any,  interference  with  nature's  plan.  The  relationship  of  the 
upper  and  lower  second  deciduous  molars  is  similar  to  that  of 
the  first  permanent  molars;  the  first  temporary  molars  and 


Fig. 


cuspid  have  similar  interdigitations  to  that  of  the  bicuspids, 
although  not  so  perfect — the  incisors  also  having  similar  rela- 
tions to  the  permanent  incisors  in  occlusal  relations.  The 
first  permanent  molars  erupt  just  posterior  to  the  second 
temporary   molars   at   the  age  of  sLx  years.     These   teeth, 


OCCLUSION 


17 


through  a  wise  provision  of  nature,  are  guided  into  place  and 
interlock  before  the  loss  of  the  temporary  molars,  thereby 
becoming  the  landmarks  or  keys  to  occlusion.  In  order  to 
have  these  keys  in  normal  occlusal  relations  it  is  necessary 
to  preserve  the  temporary  molars  until  the  eruption  and 
interlocking  of  the  first  permanent  molars. 


Fig.  3. 


These  hrst  permanent  molars  are  the  largest  and  strongest 
of  the  permanent  set,  although  they  are  the  most  neglected 
because  of  their  early  eruption,  parents  often  mistaking  them 
for  temporary  teeth.     As  they  are  the  most  important  teeth 


1 8  ESSENTIALS    OF    ORTHODONTIA 

of  the  permanent  set,  their  loss  becomes  a  serious  menace  in 
the  estabHshment  of  normal  occlusion.  The  width  of  the 
temporary  molars  from  distal  to  mesial  is  a  httle  greater  than 
that  of  the  bicuspids.  This  provision  of  nature  is  undoubt- 
edly for  the  purpose  of  allowing  the  bicuspids  room  to  prop- 
erly interdigitate  before  the  pressure  of  approximal  contact 
is  brought  to  bear  upon  them. 

In  normal  occlusion  the  mesio-buccal  cusp  of  the  upper 
lirst  molar  strikes  in  the  groove  between  the  mesio-buccal 
cusp  and  middle-buccal  cusp  of  the  lower  first  molar. 

The  upper  second  bicuspid  strikes  between  the  lower  first 
molar  and  second  bicuspid.     The  upper  first  bicuspid  strikes 


Fig.  4. 


Fig. 


between  the  lower  second  bicuspid  and  first  bicuspid.  The 
upper  cuspid  strikes  between  the  lower  first  bicuspid  and  cus- 
pid. The  relation  of  the  upper  cuspid  to  the  lower  cuspid  and 
first  bicuspid  forms  landmarks  or  lines  of  diagnosis  for  deter- 
mining deviations  in  malocclusions.  This  point  of  diagnosis 
is  especially  useful  in  cases  which  come  under  Class  I  (Angle 
classification). 

The  upper  lateral  incisor  strikes  the  mesial  third  of  the 


OCCLUSION 


19 


lower  cuspid  and  distal  half  of  lower  lateral.  The  upper 
central  incisor  strikes  the  mesial  half  of  lower  lateral  and 
entire  labio-incisal  surface  of  lower  central  incisor.  The 
upper  second  molar  strikes  the  distal  two-thirds    of  lower 


Fig.  6. 


¥k 


Fig.  8. 


second  molar  and  mesial  third  of  lower  third  molar.  The 
upper  third  molar  strikes  the  distal  two-thirds  of  lower  third 
molar.  Normal  occlusion  is  shown  in  Pigs.  4.  5.  and  6.  Figs. 
7  and  8  show  occlusal  views  of  the  case. 


20  ESSENTIALS    OF    ORTHODONTIA 

ANGLE'S  CLASSIFICATION 

Class  I. — Arches  in  normal  mesio-distal  relations. 
Class  n. — ^Lower  arch  distal  to  normal  in  its  relation  to 
the  upper  arch. 

Division    i. — Bilaterally    distal,    protruding   upper 

incisors. 
Primarily,  at  least,  associated  with  mouth-breathing. 
Subdivision. — Unilaterally  distal,  protruding  upper 

incisors. 
Primarily,  at  least,  associated  with  mouth-breathing. 
Division    2. — Bilaterally  distal,  retruding  upper  in- 
cisors. 
Normal  breathers. 
Subdivision. — Unilaterally    distal,    retruding    upper 

incisors. 
Normal  breathers. 
Class  ni. — ^Lower  arch  mesial  to  normal  in  its  relation  to 
the  upper  arch. 

Division. — Bilaterally  mesial. 
Subdivision. — Unilaterally  mesial. 


CHAPTER  III 
ETIOLOGY 

In  summing  up  the  causes  which  produce  malocclusion,  a 
great  many  have  been  assigned,  several  of  which  are  imper- 
fectly understood,  and  some  entirely  devoid  of  reason.  The 
causes  which  have  been  given  most  prominence  of  late  are: 

Early  loss  of  the  deciduous  teeth. 

Prolonged  retention  of  the  deciduous  teeth. 

Loss  of  the  permanent  teeth. 

Accidents. 

Obstruction  in  the  nasal  and  naso-pharjoigeal  passages, 
such  as  adenoids,  hypertrophy,  etc. 

Imperfect  fillings  and  crowns. 

Delayed  eruption  of  the  permanent  teeth. 

Absence  of  tooth  germs. 

Habits. 

Transposed  teeth  and  torsion. 

It  seems  that  transposed  teeth  and  torsion  are  conditions 
of  malpositions,  and  should  therefore  not  be  classed  as  causal 
factors.  In  Class  I  the  irregularity  is  restricted  usually  to  the 
teeth  anterior  to  the  first  molars,  the  exception  being  that 
the  molars  may  be  in  either  buccal  or  lingual  malposition. 
The  cases  which  usually  come  under  this  most  prevalent  class 
consist  of  deflection  of  teeth  from  their  normal  course  in 
eruption;  also  by  the  early  loss  of  the  temporary  teeth  which 
leaves  the  arch  so  narrow  that  the  permanent  teeth,  when 
they  are  ready  to  take  their  place  in  the  arch,  are  either  badly 
crowded  or  are  prevented  from  erupting  altogether. 

21 


2  2  ESSENTIALS    OF   ORTHODONTIA 

In  Class  II,  where  the  lower  arch  is  distal  to  normal 
in  its  relation  to  the  upper  arch,  the  cause  may  be  varied  from 
premature  loss  of  the  lower  temporary  teeth,  which  would 
cause  a  crowded  condition  in  this  arch;  to  lack  of  development 
through  loss  of  lower  permanent  teeth.  The  crowns  of  the 
biscuspids  lie  embedded  between  the  roots  of  the  temporary 
molars  and  are  rarely  deflected  from  their  normal  course  in 
erupting,  except  it  be  in  cases  where  caries  has  separated 
the  roots  of  the  temporary  molars  and  a  small  portion  of  a 
root  has  been  retained,  diverting  the  bicuspid  from  its  nor- 
mal course. 

In  too  long  retention  of  the  lower  temporary  central 
incisors,  the  permanent  centrals  usually  erupt  lingual  to 
normal,  thus  producing  a  condition  which  necessitates  the 
use  of  the  expansion  arch.  It  is  obvious  that  it  is  easier  to 
correct  malpositions  which  are  caused  by  too  long  retention 
of  the  deciduous  teeth  than  malpositions  resulting  from  pre- 
mature loss  of  the  deciduous  teeth. 

Notice  Figs.  9  and  10.  This  case  of  Class  II,  Division  2, 
was  caused  by  the  loss  of  the  left  lower  first  permanent  molar 
at  the  age  of  eleven  years,  thus  allowing  the  lower  bicuspids, 
cuspid  and  incisors  to  drift  back  the  width  of  a  bicuspid 
tooth,  which  nearly  closed  up  the  space  made  through  loss 
of  the  molar  on  this  side. 

In  Class  III,  the  cause  of  irregularity  is  usually  associated 
with  the  upper  arch,  which  in  most  cases  is  lacking  in  develop- 
ment. Owing  to  the  difficulty  in  treating  this  class  of  cases, 
it  is  advisable  to  begin  treatment  as  early  as  possible.  Open- 
bite  malocclusion  may  appear  in  any  one  of  the  three  classes; 
but  it  is  more  often  found  in  Class  I  or  neutroclusion.  It  is 
characterized  by  a  space  between  the  upper  and  lower  anterior 
teeth  from  cuspid  to  cuspid,  in  some  cases  involving  the 
bicuspids  and  even  the  first  molars. 


ETIOLOGY 


23 


''The  cause  of  open-bite,  or  lack  of  occlusion  of  the  an- 
terior teeth,  is  somewhat  shrouded  in  m}'stery.  Various 
theories  have  been  suggested,  notable  among  which  is  that  of 
tongue-sucking  and  mouth-breathing.  However,  it  is  the 
writer's  belief  that  prolonged  retention  of  the  second  deciduous 
molars  is  responsible  for  this  condition  of  malocclusion  in  the 
great  majority  of  such  cases.  In  all  cases  of  the  typical  form 
of  open-bite  malocclusion  there  is  supra-occlusion  of  the  molars. 


Fig.  9.  Fig.  10. 

Figs.  9  and  10. — The  loss  of  the  left  lower  first  permanent  molar  has  changed  the 
occlusal  relations  of  all  the  teeth  in  both  arches  from  the  right  cuspids  to  the  left 
third  molars.  The  space  made  by  the  loss  of  the  lower  first  molar  has  nearly  closed 
up,  not  by  the  mesial  drifting  of  the  second  and  third  molars  on  this  side,  but  by  the 
distal  drifting  of  the  left  lower  bicuspids,  cuspids  and  incisors.  This  has  resulted  in 
malinterdigitation  and  excessive  over-bite  of  the  upper  incisors. 


This  supra-occlusion  of  the  molars  should  receive  more 
attention  than  is  generally  conceded,  since  it  is  really  the 
cause  of  the  infra-occlusion.  This  supra-occlusion  of  the  molars 
is  directly  traceable  to  prolonged  retention  of  the  deciduous 
second  molars. 

The  writer  has  models  which  clearly  show  this,  as  will  be 
seen  from  the  accompanying  illustrations,  which  speak  for 
themselves.     The  germs  of  the  first  permanent  molars  are 


24  ESSENTIALS    OF    ORTHODONTIA 

the  first  permanent  tooth  germs  formed,  and  they  are  as  a  rule 
the  first  permanent  teeth  to  erupt,  and  are  the  largest  and 
strongest  of  the  permanent  teeth.  These  first  permanent 
molars  are  the  teeth  which  determine  the  length  of  bite;  that 
is,  the  length  of  over-bite  of  the  upper  anterior  teeth,  erupting 
as  they  do  just  back  of  the  second  temporary  molars  at  the 
age  of  six  years,  and  becoming  firmly  locked  before  the  loss 
of  the  deciduous  molars. 

These  teeth,  the  first  permanent  molars,  serve  as  props 
to  hold  the  jaws  apart  while  the  temporary  molars  are  being 
shed,  and  their  permanent  successors — the  bicuspids — are 
erupted  into  place  and  interlock."* 

If  in  the  course  of  the  eruption  of  the  second  bicuspids  the 
temporary  molars  are  forced  slightly  from  their  sockets,  the 
bite  is  lengthened  and  the  anterior  teeth  do  not  occlude,  the 
incisors  being  propped  apart  by  the  extruded  second  tem- 
porary molars.  In  some  cases  these  temporary  molars  be- 
come sore,  mastication  is  thereby  impaired,  and  the  child 
refrains  as  much  as  possible  from  using  the  teeth.  The  evil 
is  thus  enhanced,  for  the  first  permanent  molars  being  held 
further  apart  than  normal,  erupt  until  they  occlude  and 
become  firmly  locked,  and  finally  the  temporary  molars  are 
lost,  or  are  in  some  instances  pushed  out  by  the  erupting 
bicuspids.  The  bicuspids  being  held  further  apart  than 
normal  by  the  already  locked  molars,  erupt  until  they 
occlude.  The  anterior  teeth  being  held  still  further  apart 
never  erupt  sufficiently  to  occlude.  Thus  we  have  open-bite 
malocclusion.  This  class  of  malocclusion  interferes  greatly 
with  mastication,  and  also  with  the  speech  of  the  patient, 
causing  the  characteristic  lisping.  Infra-occlusion  is  by  far 
the  most  difficult  class  of  malocclusion  to  treat,  so  that  the 

*  See  paper  read  by  the  writer  before  the  New  Jersey  State  Dental  Society, 
July  21,  191 1.     Published  in  the  Items  of  Interest,  December,  191 1. 


ETIOLOGY  25 

prevention  of  the  primary  cause,  too  long  retention  of  the 
deciduous  second  molars,  is  the  only  correct  treatment.  Great 
caution  should  be  used,  however,  as  too  early  extraction  of 
these  teeth  would  cause  another  form  of  malocclusion,  namely, 
an  excessive  over-bite  of  the  upper  anterior  teeth,  together 
with  other  associated  forms  of  irregularity. 

Too  early  loss  of  the  deciduous  molars  would  allow  the 
jaws  to  come  too  close  together,  thereby  preventing  the 
permanent  molars  from  erupting  as  far  as  normal,  which 
causes  permanent  excessive  over-bite  of  the  upper  incisors,  as 
well  as  prevents  normal  development  of  the  jaws,  resulting  in 
a  crowded  condition  of  the  bicuspids  when  they  erupt,  or 
preventing  their  normal  eruption.  In  no  case  should  the 
second  temporary  molars  he  extracted  before  the  eruption  and 
interlocking  of  the  first  permanent  molars. 

Good  judgment  should  be  used  in  preserving  the  temporary 
teeth,  for  in  some  cases  where  decay  exists — and  even  where 
decay  does  not  exist — the  normal  absorption  and  loosening  of 
the  deciduous  molars  does  not  take  place. 

The  law  laid  down  by  Dr.  Angle  covers  this  point  very 
thoroughly.  "Whenever  a  temporary  tooth  is  found  inter- 
fering with  the  eruption  of  its  permanent  successor,  it  should 
be  removed  regardless  of  the  time." 

"The  thickened  process  over  the  roots  of  the  temporary 
teeth  usually  indicates  the  eruptive  force  of  the  permanent 
teeth,  and  is  a  warning  for  extraction.  If  greater  care  were 
given  the  temporary  teeth,  there  would  be  fewer  cases  of 
malocclusion.  Treatment  of  the  temporary  teeth  is  very 
much  neglected,  and  injudicious  extraction  is  too  often 
practised. 

There  are  some  cases  of  this  class  of  malocclusion,  where 
the  infra-occlusion  of  the  incisors  is  very  slight,  that  will 
yield  to  the  treatment  of  extruding  the  anterior  teeth,  pro- 


26 


ESSENTIALS    OF    ORTHODONTIA 


vided  the  tension  on  the  lips  is  not  overtaxed  and  proper 
nasal  breathing  is  established. 

In  patients  who  have  advanced  in  years,  treatment  is  not 
successful,  yet  some  relief  is  afforded  by  grinding  the  occlusal 
surfaces  of  the  supra-occluded  molars.  The  practice  of 
extruding  the  anterior  teeth  is  not  a  very  satisfactory  one,  the 
results  not  being  permanent,  for  development  never  takes 
place  normally.  In  fact,  to  lengthen  the  bite  in  this  manner  is 
abnormal."^ 

Fig.  II  illustrates  the  beginning  of  a  case  of  open-bite 
malocclusion  in  a  girl  thirteen  years  of  age.  Notice  that  the 
extruded  upper  second  temporary  molar  is  the  sole  cause  of 


1                         II 

^^Hjl^^^^^;^^^^^ 

H 

5i/'< 

m 

1 

Fig.  II. 

the  infra-occlusion  of  the  anterior  teeth.  The  upper  second 
bicuspid,  instead  of  being  deflected  from  its  course,  is  erupting 
in  a  normal  line,  pushing  the  deciduous  molar  from  its  socket. 
The  same  condition  prevailed  on  the  opposite  side,  but 
unfortunately  the  temporary  molar  was  extracted  before  the 
writer's  attention  was  called  to  the  case. 

Fig.  12  shows  front  view  of  the  case  illustrated  in  Fig. 


^  Dalton,  "La  Cause  De  La  Beance  De  L'Occlusion."    Le  Laboratoire  et  Le 
Progres  Dentaire,  Jan.,  191 2. 


ETIOLOGY  27 

II.  Notice  how  great  a  space  is  produced  in  the  incisor 
region  by  only  slight  supra-occlusicn  of  the  first  permanent 
molars.  The  infra-occlusion  was  slightly  reduced  after 
extraction  of  the  temporary  molars  and  still  further  reduced 
by  grinding  the  first  permanent  molars. 

Fig.  13  illustrates  another  case  of  too  long  retention  of 
the  temporary  molars.  The  cusps  of  the  lower  cuspid  and 
first  bicuspid  are  just  showing.  The  first  temporary  molar 
was  lost  only  the  day  before  the  impression  was  taken. 

Fig.  14  shows  the  anterior  view  of  the  case  illustrated  in 
Fig.  13.  Note  the  shifting  of  the  median  line  in  the  upper 
arch  toward  the  affected  side. 

Fig.  15  illustrates  a  case  showing  the  second  upper  tem- 
porary molar  in  the  model.  The  tooth  came  away  "s\ith  the 
plaster  impression.  This  patient  has  an  almost  end-to-end 
bite. 

Fig.  16  illustrates  the  beginning  of  a  case  of  open-bite 
malocclusion  in  a  patient  only  eight  years  of  age. 

Figs.  17  and  18  illustrate  the  models  of  two  cases  secured 
immediate!}^  after  extraction  of  the  temporary  molars  which 
had  been  retained  too  long,  causing  supra-occlusion  of  the 
first  permanent  molars  with  consequent  infra-occlusion  of 
the  incisors. 

Figs.  19,  20  and  21  illustrate  a  case  where  the  lower  arch 
and  teeth  are  beautifully  developed  while  great  irregularity 
and  inharmony  prevails  in  the  upper  arch,  caused  primarily 
at  least  by  too  long  retention  of  the  upper  second  deciduous 
molars.  The  temporary  teeth  show  dark  in  the  illustration 
because  they  are  the  natural  teeth  which  came  away  with  the 
impression,  plaster  being  used  as  impression  material. 

Figs.  22,  23  and  24  show  another  case  where  the  retention 
of  the  eight  temporary  molars  was  causing  complicated 
trouble.     Unfortunately  the  illustrations  do  not  give  a  very 


28 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  12. 


Fig.  13. 


Fig.  14. 


Fig.  15. 


Fig.  16. 


Fig.  17. 


ETIOLOGY 


29 


Fig.   i^. 


Fi...    lu. 


Fig.  20. 


Fig.  21. 


m 

<• 

m 

im 

^9j^ 

W^^^ 

■ 

^  ^ 

i 

1' 

Fig.  22. 


Fig.  23. 


30 


ESSENTIALS    OF   ORTHODONTIA 


Fig.  24. 


Fig.  2- 


¥^ 

9^ 

«* 

tutP^ 

"v               '                                                      1 

Fig.   20. 


Fig.   27. 


Fig.   28. 


ETIOLOGY  31 

good  idea  of  the  conditions  which  existed  in  this  case.  Im- 
mediately after  the  impressions  were  taken  the  eight  tem- 
porary molars  were  extracted  and  placed  in  the  impression, 
because  it  was  the  writer's  intention  to  get  models  which 
represented  the  original  condition  as  nearly  as  possible. 

Fig.  25  illustrates  a  pecuhar  case.  The  lower  first  and 
second  bicuspids  are  erupting  mesial  and  distal  to  the  lower 
second  temporary  molar.  The  reason  for  this  is  that  the  lower 
first  permanent  molar  had  been  extracted.  This  temporary 
molar  was  extracted  because  it  was  producing  infra-occlusion. 

Figs.  26  and  27  illustrate  a  case  where  the  upper  temporary 
molars  on  the  right  side  had  caused  open-bite  malocclusion. 
This  model  was  found  in  the  college  collection  and  bears  the 
date  of  1884,  clearly  showing  that  the  same  conditions  existed 
years  ago. 

Fig.  28  illustrates  a  typical  case  of  open-bite  malocclusion 
which  was  doubtless  caused  by  too  long  retention  of  the 
deciduous  molars,  for  the  patient  is  not  a  mouth  breather, 
nor  does  she  remember  ever  having  been  addicted  to  any  of 
the  so-called  '^ habits"  of  childhood,  although  she  does  remem- 
ber having  temporary  teeth  extracted  only  three  years  prior 
to  treatment. 


CHAPTER  IV 
FACIAL  ART 

It  has  already  been  pointed  out  by  a  great  writer  in 
Orthodontia  that  a  large  number  of  our  patients  would  not 
reach  us  were  it  not  for  the  fact  that  great  inharmony  in  the 
features  of  the  face  is  so  closely  associated  with  malocclusion. 
In  fact,  facial  harmony  is  so  closely  connected  with  normal 
occlusion  that  there  cannot  be  deviation  in  the  one  without 
proportionate  disturbance  in  the  other.  To  those  who  under- 
stand the  classifications,  it  is  easy  to  diagnose  pronounced 
cases  which  belong  to  Classes  II  and  III,  without  even 
examining  the  teeth  or  taking  the  impression.  And  the  writer 
believes  it  would  be  good  practice  for  the  student,  being 
assigned  a  case  in  the  clinic,  to  make  such  diagnosis  mentally 
before  examining  the  teeth  and  taking  the  impression,  so  that 
comparison  could  later  be  made  for  verification. 

The  use  of  the  clay  model  of  the  face  in  lectures  is  for  the 
purpose  of  impressing  upon  the  student  the  indissoluble  asso- 
ciation of  facial  harmony  and  occlusion,  of  facial  inharmony 
and  malocclusion.  The  plaster  cast,  Fig.  29,  was  taken  from 
a  face  where  normal  occlusion  is  evidenced  by  proportionate 
harmonious  development  of  the  facial  lines. 

In  Fig.  30,  the  profile  of  a  patient  suffering  with  marked 
distoclusion  is  represented  in  moldable  clay.  The  upper  part 
of  the  face  is  molded  along  lines  similar  to  those  shown  on  the 
upper  part  of  the  plaster  cast.  Fig.  29  but  the  lower  jaw  is  set 
back  in  a  receding  manner,  which  is  t>'pical  of  pronounced  cases 
of  this  type. 

In  Class    III,  Fig.  31,   the  apparent  protruding  chin  is 

32 


FACIAL    ART 


33 


effected  by  retruding  the  upper  jaw  and  lips,  this  also  being 
typical  of  this  class  of  malocclusion.  Of  course  there  might 
be  comphcations  arising  in  both  Classes  Hand  III,  for  instance 


Fig.  29. 

in  Class  III  there  might  be  lack  of  development  in  the 
upper  arch  associated  with  pronounced  development  of  the 
lower  arch,  although  this  is  rare,  and  when  seen  is  probably 


34 


ESSENTIALS    OF    ORTHODONTIA 


due  to  loss  of  the  interdigitating  relations  of  the  occlusal 
inclined  planes  of  the  cusps  of  the  teeth;  for  where  the  lin- 
gual surfaces  of  the  lower  incisors  occlude  against  the  labial 


surfaces  of  those  of  the  upper  jaw,  would  not  that  be  a  factor 
in  causing  greater  inharmony  in  the  relations  of  the  dental 
arches? 


FACIAL    ART 


35 


The  constant  labial  pressure  against  the  upper  teeth  pre- 
vents any  further  development  of  that  arch,  while  the  force 
exerted  against  the  lingual  surfaces  of  the  lower  teeth  would 
stimulate  that  arch  to  further  development,  as  is  sometimes 
seen  where  there  are  spaces  between  the  lower  cuspid  and 
bicuspid,  Figs.  32  and  ;^t,,  while  the  upper  arch  is  sadly 
lacking  in  development. 

In  cases  of  this  abnormal  inlocking  of  the  upper  incisors, 
should  the  supper  arch  succeed  in  further  development  there 
would  be  likewise  further  development   (abnormal)   of  the 


Fig.  32. 


Fig.  33. 


lower  arch,  which  would  complicate  matters  still  more,  for  the 
distal  movement  of  the  lower  teeth  in  this  class  is  not  so  easily 
accomplished  as  mesial  movement  of  the  upper  teeth. 

The  importance  of  early  treatment  in  this  class  of  cases 
can  hardly  be  over-estimated.  Figs.  34  and  35  show  a  typical, 
though  not  pronounced,  case  of  Class  III  in  a  young  girl  of 
thirteen.  The  inlocked  upper  incisors  were  undoubtedly 
carrying  the  lower  anterior  teeth  further  forward  than  normal, 
although  there  was  loss  of  molar  teeth  on  both  sides  in  the 
lower  arch  some  three  vears  before  treatment. 


36 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  34. 


Fig.  3; 


Fig.  36. 


Fig.  37. 


Fig.  38. 


Fig.  39. 


FACIAL   ART  37 

Figs.  36  and  37  show  the  case  immediately  after  treatment. 
This  is  a  pecuHarly  interesting  case  from  the  fact  that  this 
same  case  has,  six  years  later,  developed  into  a  Class  II  case, 
the  lower  anterior  teeth  having  drifted  back  into  the  space 
made  through  the  loss  of  molar  teeth  at  the  age  of  ten  years, 
for  after  the  pressure  was  remo\'ed  from  the  lower  anterior 
teeth,  they  slowly  drifted  distally.  Figs.  ^,8  and  39  show 
occlusal  views  of  the  case  before  and  after  expansion  of  the 
upper  arch. 

It  is  the  writer's  belief  that  the  use  of  the  clay  model  is 
far  more  effective  in  teaching  facial  art  in  its  relation  to  oc- 
clusion than  the  use  of  chart  diagrams  of  the  face.  Surely 
the  indisputable  fact  of  the  close  association  of  the  two  could 
not  be  portrayed  more  vividly  than  in  Figs.  29  and  30. 


CHAPTER  V 
IMPRESSION  AND  MODEL  MAKING 

The  majority  of  orthodontists  agree  on  plaster  as  an 
impression  material,  and  there  is  no  doubt  of  its  superiority 
over  other  impression  materials;  however,  it  is  the  writer's 
beHef  that  it  is  better  for  the  student  to  use  modeling 
compound. 

Good  models  can  be  made  from  modehng  compound 
impressions,  if  carefully  and  intelligently  handled.  The  writer 
has  reached  this  conclusion,  after  having  tried  to  start 
classes  to  take  plaster  impressions  from  the  beginning.  In 
95  per  cent,  of  these  cases  failure  resulted,  due  no  doubt  to 
the  fact  that  the  beginners  were  not  familiar  enough  with  the 
working  of  plaster  to  handle  it  with  self-confidence,  for  as  soon 
as  they  experienced  any  trouble  in  dislodging  a  portion  of 
the  impression  they  became  excited  and  nervous  and  this 
was  quickly  transmitted  to  the  patient,  with  disastrous 
results. 

After  one  has  become  familiar  with  the  taking  of  impres- 
sions, then  it  would  be  wise  to  use  plaster  and  proceed  along 
prescribed  rules  for  using  this  material. 

In  the  use  of  modeling  compound  select  trays  that  are 
slightly  larger  than  the  arch,  always  using  the  specially  made 
trays,  for  the}'  are  the  only  ones  which  will  carry  the  impres- 
sion material  high  up  underneath  the  lip  and  cheek,  which  is 
very  essential  in  order  to  obtain  good  models  (Figs.  40  and  41). 

After  selecting  the  proper  tray  and  trying  it  in  the  mouth, 
soften  the  compound  in  warm  water,  as  this  more  evenly 

38 


IMPRESSION    AND    MODEL    MAKING  39 

distributes  the  heat  than  where  dry  heat  is  employed.  Place 
the  softened  compound  in  the  selected  tray,  using  a  larger 
amount  of  compound  in  the  anterior  part  of  the  tray  for  either 
upper  or  lower  impression.  Then  force  well  into  position  and 
hold  securely  in  place  with  the  second  finger  of  the  left  hand 
in  the  palatine  portion  of  the  tray  (Fig.  42).  Then  place  the 
index  finger  of  the  right  hand  at  the  heel  of  the  tray  and 
go  around  the  edge  of  the  tray,  forcing  the  compound  well 
under  the  lip,  after  which  the  lip  should  be  pressed  gently 
against  the  compound  and  tray  in  order  to  adapt  the  impres- 
sion material  more  accurately. 

Next  take  a  syringe,  which  has  been  previously  filled 
with  cold  water  and  chill  the  impression  thoroughly,  then 
carefully  remove  the  impression  and  wash  it  immediately 
in  cold  water,  after  which  it  may  be  poured  at  an  opportune 
time. 

TAKING  PLASTER  IMPRESSIONS 

Before  proceeding  to  take  an  impression,  it  is  well  to 
remove  any  tartar  which  may  be  present  and  polish  the  teeth 
thoroughly  with  an  orangewood  stick  and  pumice.  Xever 
use  bristle  brush  wheels  in  the  engine.  Select  a  tray  that  is 
slightly  larger  than  the  arch,  practically  the  same  as  if  using 
modeling  compound,  with  the  exception  that  the  tray  must  be 
absolutely  smooth  and  free  from  scratches.  Any  bending  of 
trays  must  be  outward,  and  not  inward,  as  it  is  necessary  to 
remove  the  tray  from  the  plaster. 

Place  medium  stiff  plaster  in  the  anterior  part  of  the  tray, 
and  with  the  spatula  distribute  a  little  to  each  heel  of  the  tray. 
Always  have  an  excess  of  plaster  in  the  anterior  part  of  the 
tray  so  as  to  get  a  high  impression  (Fig.  43). 

In  taking  an  upper  impression  care  should  be  exercised  to 
avoid  getting  any  plaster  in  the  palatine  part  of  the  tray,  as 


40 


ESSENTIALS    OF    ORTHODONTIA 


this  would  force  back  on  the  soft  palate,  annoy  the  patient 
and  possibly  spoil  the  impression  altogether.  Gently  force 
the  tray  into  position  and  hold  it  as  when  using  modeling 
compound.  Never  attempt  to  hold  the  tray  by  the  handle. 
Then  with  the  index  finger  of  the  right  hand,  force  plaster 


Fig.  41. 


well  up  under  the  lip,  after  which  the  lip  should  be  drawn 
gently  toward  the  handle  of  the  tray  and  released.  The 
excess  plaster  on  the  handle  of  the  tray  should  next  be 
removed  with  pledgets  of  cotton. 

After  the  plaster  has  hardened  sufficiently  (use  remaining 


IMPRESSION    AND    MODEL    FLAKING 


41 


plaster  in  bowl  as  a  test),  remove  the  tray,  being  careful  to 
avoid  removing  any  plaster  with  the  tray  (Fig.  44).  Cut 
two  grooves  almost  through  the  plaster  at  the  cuspid  region 
(Fig.  45).  Then  break  away  the  labial  section,  using  the 
impression  remover  (Fig.  46).  Next  break  the  two  buccal 
sections  away,  using  the  impression  remover  as  before. 
With  the  special  impression  remover  (Fig.  47),  gently  loosen 
the  lingual  section,  and  if  the  tray  has  been  forced  well  into 
position  and  care  been  exercised  there  should  be  only  four 
pieces  of  the  impression  to  assemble  (Figs.  48  and  49),  al- 
though more  pieces  than  this  should  occasion  no  regrets.  The 
assembling  of  the  impression  should  be  done  outside  the  tray, 


Fig.  43. 


unless  the  impression  is  badly  broken,  when  it  is  advisable  to 
use  the  tray,  as  this  will  aid  in  assembling  the  small  frag- 
ments, preventing  loss  of  the  fine  serrations,  which  would 
otherwise  happen  with  frequent  handling.  The  united  parts 
should  be  held  by  means  of  melted  wax  flowed  over  the 
outside  of  the  impression. 

IMPORTANCE  OF  GOOD  MODELS 

It  is  of  the  utmost  importance  that  the  models  shall  be 
as  nearly  perfect  as  possible,  and  it  is  impossible  to  get  perfect 
models  without  first  securing  good  impressions.     On  the  other 


42 


ESSENTIALS    OF    ORTHODONTIA 


hand,  models,  no  matter  how  perfect  the  impression,  lose  their 
value  if  poured  in  a  haphazard  style.  Plenty  of  plaster  should 
be  used  in  pouring  up  impressions  so  that  they  may  be 
trimmed  along  certain  prescribed  artistic  lines.     Never  build 

up  a  model   higher   at   the 

anterior   part   than   at   the 

heel.     (See   Fig.    50.)     The 

correctly  trimmed  model  is 

shown     in     Fig.     51.     The 

^^^-  44-  lower     model     is    trimmed 

along  similar  lines  to  that  of  the  upper  with  the  exception 

that  the  lower  is  usually  rounded  from  cuspid  to  cuspid  as 

shown  in  Fig.  52. 

During  the  progress  of  treatment  of  cases  reference  should 


Fig.  45. 

frequently  be  made  to  the  original  models.  This  is  important, 
for  patients  are  quick  to  note  changes  which  occur  in  their 
teeth. 

Models  should  not  he  varnished;  nor  shoidd  they  he  articu- 
lated.    Comparing   the   models   with    the   occlusion   of    the 


IMPEESSIOX    AND    MODEL    MAKING 


43 


teeth  in  the  patient's  mouth,  marking  them  hghtly  in  order  to 
serve  as  a  guide  for  their  relation,  is  far  better  and  more  artis- 
tic than  to  detract  from  their  appearance  through  the  use  of 
articulators. 


Fig.  46. 

After  the  desired  tooth  mo\'ement  has  been  accomphshed; 
the  apphance  removed  and  teeth  cleaned  preparatory  to  fitting 
retention  devices,  impressions  should  again  be  taken  in  order 
to  obtain  models  of  the  corrected  case.     These  models  should 


j> 


Fig.  47. 

be  deposited  in  the  cabinet  alongside  those  secured  at  the 
beginning  of  the  treatment  so  that  comparison  may  be 
made,  and  a  study  of  the  changes  in  position  of  the  teeth  be 
noted,  which  is  of  material  importance  in  deciding  on  a 
means  of  retention. 

Models  should  be  labeled  and  placed  in  a  suitable  cabinet 
for  future  study  and  reference.     (See  J'ig.  53.)    ^ 


44 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  48. 


Fig.  50. 


Fig.  49. 


Fig.  sr. 


Fig.  52. 


Fig.  53. 


CHAPTER  VI 
BAND-MAKING 

There  are  various  kinds  of  ready-made  bands  on  the  mar- 
ket, but  a  carefully  made  plain  band  is  far  better  than  any  of 
these,  and  they  can  be  made  and  adapted  in  about  the  same 
length  of  time  that  it  takes  to  adjust  a  ready-made  band.  The 
writer's  method  is  to  cut  strips  of  nickel  silver  of  two  thick- 
nesses, about  34  and  35  gauge  and  place  in  a  suitable  box 
(Fig.  54)  ready  for  use. 

On  being  assigned  a  case,  and  after  having  determined 
upon  the  method  of  procedure,  select  a  strip  of  band  material 
from  the  stock  box  of  suitable  width,  then  draw  it  through  the 
hand-forming  pliers  (Fig.  55)  in  order  to  smooth  down  the  up- 
turned edges.  Next  adapt  around  the  tooth  to  be  banded  and 
pinch  together  on  the  lingual  surface  of  the  tooth,  always 
drawing  the  band  together  on  the  lingual  side  in  order  to  leave 
the  buccal  side  free  for  the  soldering  of  the  sheath  or  tube.      , 

Still  holding  the  ends  of  the  band  together  with  the 
band-forming  pliers,  remove  as  a  whole  by  manipulating  the 
pliers. 

If  the  teeth  are  bad!}'  crowded  together  this  may  be  impos- 
sible. In  such  cases  release  the  grasp  on  the  band  material 
with  the  pliers,  then  work  the  band  from  the  proximal  sur- 
faces. After  removal,  adapt  the  ends  together  and  hold 
with  the  band-soldering  pliers. 

Do  not  weaken  the  band  by  cutting  it  out  on  the  proximal. 

In  order  to  be  stable  the  band  should  remain  the  same 
width  all  around  and  should  go  under  the  gum  on  the  proxi- 
mal surfaces. 

45 


46 


ESSENTIALS    OF    ORTHODONTIA 


Plain  bands  adapted  to  teeth  and  allowed  to  be  worn  for 
a  day  or  two  before  soldering  the  sheaths  or  tubes,  will  gain 
space,  and  allow  of  greater  ease  in  cementing. 

Bands  should  not,  however,  be  allowed  to  remain  in  posi- 


FiG.  54. 

tion  longer  than  two  days  uncemented,  for  fear  of  injury  to 
the  enamel. 

Where  the  teeth  are  wedged  together  near  or  approximat- 
ing the  tooth  to  be  banded,  it  is  well  to  secure  a  space  on  one 
proximal  surface  of  the  tooth  to  be  banded  by  means  of  a 


"^ 

^E^.  ^'^^ 

^ 

■ 

.  "^ 

r 

^ 

ki.*.*         VI 

^^p^ 

1 

jfl 

^^^B^'     ^Ib. 

r< 

1 

1: 

Fig 


thin  separating  rubber  strip,  placed  in  position  on  the  day 
previous  to  the  construction  of  bands.  Xeier  allow  the  rubber 
strip  to  remain  in  position  longer  than  one  day  and  night,  for 
fear  of  injury  to  the  gums.     Remember  that  the  contact  point 


BAND -MAKING  47 

of  the  teeth  is  near  the  occlusal  surface,  so  do  not  allow  the 
rubber  to  slip  entirely  into  the  inter-proximal  space  (Fig.  56). 
The  correctly  placed  rubber  is  shown  in  Fig.  57. 

One  rubber  strip  is  sufficient  to  each  tooth  to  be  banded. 
Xever  use  two,  as  this  would  cause  soreness  of  the  tooth  and  is 
altogether  unnecessary. 

The  securing  of  space  is  advisable  in  most  cases,  for  where 
the  teeth  are  close  together  the  band  material  will  not  slip 
in  between  them  on  being  drawn  together  with  the  pliers, 
although  it  might  be  difficult  to  remove,  giving  the  beginner 
the  false  impression  of  a  close-fitting  band,  when  the  difficulty 
was  altogether  in  the  inter-proximal  spaces. 


Fig.  56.  Fig.  57. 

Where  it  is  necessary  to  band  any  of  the  anterior  teeth 
gold  or  gold  and  platinum  plate  may  be  substituted  for 
nickel  silver.  Cut  the  plate  into  strips  similar  to  the  nickel 
silver,  but  the  gold  must  be  of  a  greater  thickness,  as  it  is  not 
nearly  so  tough. 

Plain  bands  possess  a  distinct  advantage  over  ready-made 
bands  in  that  the  tubing  can  be  readily  changed  and  re-aligned 
to  suit  the  needs  of  each  individual  case.  This  is  not  so 
easily  done  in  certain  forms  of  ready-made  adaptable  bands, 
although  there  are  other  makes  of  adjustable  bands  which 
permit  this,  but,  unfortunately,  they  have  adjusting  nuts  on 
the  hngual  side  which  interfere  more  or  less  with  the  tongue. 


48  ESSENTIALS    OF    ORTHODONTIA 

Soldering.— Cleanliness  is  very  essential  in  all  departments 
of  orthodontia,  but  nowhere  is  it  more  so  than  in  soldering. 

After  the  band  material  has  been  adapted  and  removed 
from  the  mouth  it  should  be  held  in  running  water  to  remove 
the  saliva. 

After  having  adjusted  the  ends  together,  grasp  them  with 
the  band-soldering  pliers,  place  a  little  flux  just  at  the  contact 
point,  then  hold  in  the  flame  just  long  enough  to  dry  the  whole 
band;  this  will  prevent  the  solder  from  jumping.  Place  the 
solder  in  the  desired  position.  The  use  of  the  wire  solder  is 
recommended  in  soldering  bands.  Now  remember  that  solder 
will  flow  in  the  direction  of  the  greatest  amount  of  heat,  so  in 
order  to  prevent  its  flowing  out  on  the  sides  of  the  band,  hold 
not  the  whole  band  in  the  flame,  but  only  that  part  to  be 
soldered,  as  shown  in  Fig.  58. 

A  small  pointed  flame  is  essential  to  good  soldering  in 
orthodontia  work.  The  ordinary  Bunsen  burner  is  unsuited 
for  this  work.  The  writer  has  made  good  use  of  an  S.  S.  W. 
gold  annealer  Bunsen  (Fig.  59).  The  flame  from  this  little 
Bunsen  can  be  controlled  almost  as  weU  as  that  of  a  blowpipe 
with  the  advantage  of  being  more  convenient,  for  soldering 
bands.  But  for  soldering  spurs  and  other  more  delicate  parts 
of  an  appliance,  the  use  of  a  Griinberg  blowpipe  is  recom- 
mended, as  shown  in  Fig.  60. 

The  correct  method  of  soldering  the  buccal  tubes  and  spurs 
is  shown  in  Fig.  61.  Notice  that  it  is  necessary  to  steady  the 
hands  by  contact  of  the  third  and  little  fingers. 

Soft  Soldering. — Where  it  is  necessary  to  retain  the  temper 
in  the  expansion  arch  and  at  the  same  time  spurs  are  required, 
it  is  advisable  to  use  jewelers'  soft  solder;  it  can  be  obtained 
in  very  thin  sheets.  Only  a  very  small  piece  is  necessary  for 
these  attachments.  Phosphoric  acid  makes  a  very  good  flux 
(cement  liquid). 


BAXD-MAKIXG 


49 


Great  care  should  be  exercised  in  order  to  avoid  heating  the 
expansion  arch  any  more  than  is  necessary.  \'ery  little  heat 
is  required;  the  only  trouble  is  in  confining  it  to  the  part  to  be 
soldered. 

TREATMENT  OF  CASES 

The  application  of  the  expansion  arch  and  ligation  of 
loose  teeth  in  accidents  and  fractures. 

When  such  cases  present  themselves  for  treatment  immedi- 
ate attention  is  necessary  and  it  devolves  upon  the  general 
practitioner  either  to  give  the  treatment  or  else  refer  the 


Fig.  58. 


patient  to  a  specialist.  To  the  country  practitioner  this  is  an 
important  subject,  for  it  is  his  duty  to  treat  such  cases  if  there 
is  not  an  orthodontist  near  enough  to  give  his  services. 

The  community  expects  and  demands  that  the  dentist 
give  intelligent  advice  and  service  in  such  cases,  and  if  there  be 
no  one  to  whom  he  can  refer  such  patients  it  becomes  his  duty 
to  render  service  in  these  cases.  The  city  dentist  has  ad\an- 
tages  over  the  country  practitioner  in  that  he  is  reheved  from 


5° 


ESSENTIALS    OF    ORTHODONTIA 


further  obligation  on  his  part  by  sending  his  patients  to  a 
speciaHst. 

The  country  dentist  may  have  no  such  advantage,  con- 
sequently he  must  be  able  to  render  service  in  such  cases  so  far 
as  his  time  will  permit. 


Fig.  59. 

The  remark  is  often  made  by  students  that  they  do  not 
intend  to  do  orthodontia  work.  Such  students  slight  the 
course  in  this  subject.  It  is  all  very  well  and  good  for  the 
dentist  to  refer  his  patients  to  one  who  specializes  in  ortho- 


BAND-MAKING 


51 


dontia  work,  indeed  it  is  the  proper  thing  to  do,  but  neverthe- 
less he  ought  to  be  able  to  diagnose  any  case  of  malocclusion 
which  might  come  under  his  observation  and  give  such 
patients  intelligent  advice  as  to  the  need  and  importance  of 
orthodontia  work  being  done.     Consequently,  more  attention 


-The  Grunberg  blowpipe. 

ought  to  be  paid  to  this  very  important  subject  by  the  stu- 
dents of  general  dentistry. 

It  will  always  devolve  upon  the  country  dentist  to  do  the 
orthodontic  work  for  those  of  his  patients  who  have  not  the 
means  to  go  to  the  city  and  be  treated  by  the  specialist. 


52 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  6i. — The  correct  method  of  soldering  spurs  is  here  shown.  In  soldering 
sheaths  on  anchor  bands  the  tubing  is  held  in  a  similar  manner,  except  where  the 
tubing  has  been  cut  to  correct  length,  in  which  case  it  is  held  in  contact  with  the 
band  by  means  of  a  long  piece  of  i6-gauge  wire. 


BAND-MAKING  53 

The  writer  does  not  wish  to  be  quoted  as  advising  dentists 
to  do  orthodontic  work  indiscriminately,  for  no  one  should 
attempt  to  take  care  of  a  case  of  malocclusion  unless  he  has 
carefully  prepared  himself  for  this  work. 

A  large  number  of  dentists  have  done,  and  are  still  doing 
a  great  deal  of  harm  by  unintelligent  handling  of  cases 
of  orthodontia,  as  is  evidenced  by  these  same  cases  which 
later  come  under  the  care  of  the  specialist,  but  not  until  after 
irreparable  damage  has  been  done.  In  nearly  all  such  cases 
extraction  has  been  resorted  to  through  the  mistaken  idea  that 
it  would  simplify  the  work. 


Fig.  62. — (After  Lukens.) 

The  treatment  of  these  cases  becomes  very  difficult  after 
extraction  has  been  done,  leaving  the  arches  narrow  and  con- 
stricted through  lack  of  development  and  the  loss  of  cuspal 
interdigitation.  In  the  light  of  present  day  teaching  and 
literature  on  this  particular  branch  of  dental  science,  no  one 
can  be  excused  for  mutilating  the  occlusal  relationship  of  th€ 
dental  arches  through  extraction. 

The  adaptation  of  anchor  bands,  with  certain  modifica- 
tions, is  called  for  in  cases  of  fracture;  where  the  teeth  to  be 
used  for  this  purpose  are  not  too  sore  and  loose,  the  results 


54 


ESSENTIALS    OF    ORTHODONTIA 


obtained  are  good,  and  moreover  this  method  of  treatment  is 
more  conf  or  table  and  sanitary  than  where  an  interdental 
splint  is  used.  (See  Fig.  62.)  The  writer  has  also  met  with 
cases  of  accidents  where  the  application  of  the  alignment 


Fig.  63. — (After  Liikens.) 

wire  rendered  inestimable  service.  Most  of  these  cases  of  ac- 
cidents occurred  in  boys  who  had  been  engaged  in  the  great 
American  game  and  had  suffered  the  misfortune  of  having 


■  ^^ 

^0 

\'4 

i^ 

Fig.  64. — (After  Lukens.) 


Fig.  65. — (After  Lukens.) 


the  two,  and  in  seme  cases  the  four,  incisors  badly  loosened. 
These  loosened  teeth  were  ligated  firmly  to  the  alignment 
wire  and  antiseptic  mouth  washes  daily  prescribed  until  all 
soreness  subsided.     In  such  cases  after  four  or  five  days,  note 


BAND-MAKING 


55 


carefully  the  color  of  the  teeth  to  see  if  the  pulps  have  been 
involved.  If  death  has  ensued,  the  pulp  chamber  should  be 
opened  from  the  lingual,  cleansed,  treated  and  filled. 

Application  of  the  jack  screw  for  the  movement  of  upper 
cuspids  that  are  in  linguoversion  is  shown  in  Fig.  63. 


Fig.  66 


Fig.  67. — (After  Angle. 


Fig.  68.— (After  Angle 


nmTiuiiiiiiimiiiiiiiiiiimTgr 
Fig.  69. — (.\fter  Angle.) 


Fig.  70. — (.After  Angle.) 


Effective  methods  for  closure  of  spaces  between  the 
superior  central  incisors  is  shown  in  Figs.  64  and  65. 

Fig.  65  shows  a  rather  unique  method  of  closing  a  space 
between  the  centrals.     This  is  obtained  by  fitting  plain  bands 


56  ESSENTIALS    OF    ORTHODONTIA 

on  the  two  central  incisors,  and  instead  of  soldering  spurs  to 
the  plain  bands,  the  smooth  bore  and  threaded  eyelets  are 
removed  from  a  Lukens'  molar  clamp  band  K,  Fig.  66,  and 
soldered  to  the  plain  bands.  The  employment  of  two  expan- 
sion arches  to  form  an  intermaxillary  appliance  is  shown  in 
Figs.  67,  68,  69  and  70. 


CHAPTER  VII 

METHODS  AND  APPLIANCES 

The  expansion  arch  is  the  greatest  and  most  efficient  single 
appHance  to  be  found  in  the  whole  category  of  regulating 
devices.  The  wonderful  simplicity  and  ease  with  which  it 
can  be  adapted,  together  with  its  efficiency  in  accomplishing 


Fig.   71. — The  Lukens  expansion  arch. 

the  various  tooth  movements,  make  it  pre-eminent  among  all 
discoveries  and  inventions  relating  to  orthodontia  work.  (See 
Figs.  71,  72  and  73.)  By  use  of  bands  and  wire  ligatures  in 
conjunction  with  the  expansion  arch,  all  of  the  seven  possible 
tooth  movements  can  be  satisfactorily  accomplished,  viz., 

57 


58  ESSENTIALS    OF   ORTHODONTIA 

rotation,  intrusion,  extrusion,  retrusion,  protrusion,  mesial  and 
distal  movement.  In  Fig.  74  the  proper  adaptation  of  the 
expansion  arch  is  shown  for  the  movement  of  the  upper  incisor 
teeth  which  are  in  linguoversion.     Note  that  the  alignment  of 


Fig.  72. — The  Angle  expansion  arch. 


Fig.  73. — The  Angle  expansion  arch  (ribbed). 

the  expansion  arch  is  such  that  the  incisor  teeth  when  brought 
out  against  the  arch  will  be  in  normal  relation  to  the  line  of 
occlusion.  "As  the  twig  is  bent,  so  is  the  tree  inclined."  It 
is  also  true  that  as  the  expansion  arch  is  bent  so  will  the  teeth 
align. 


METHODS    AND    APPLIANCES 


59 


A  tooth  may  occupy  any  one  of  nine  possible  malpositions, 
as  pointed  out  by  Dr.  Lischer,  namely,  that  of  lahioversion, 
hiiccovcrsion,  linguoversion,  distoversioji,  mesioversion,  torso- 
version,  infraversion,  supraversion,  perversion  and  transversion. 

An  expansion  arch  which  is  correctly  aligned  to  the  upper 
arch  is  shown  in  Fig.  75.  The  lateral  incisors  which  are  in 
linguoversion  can  be  moved  labially  into  contact  with  the 
expansion  arch.  The  central  incisors  which  are  in  torsover- 
sion  can  be  rotated  until  their  labial  surfaces  are  in  contact 
with  the  expansion  arch,  likewise  the  bicuspids  and  first  molar 
on  the  right  side. 


Fig.  74. 


Fig.  75. 


This  in  a  measure  is  arch  predetermination,  for  after 
examining  the  relation  of  the  lower  arch  to  the  upper,  it  was 
found  that  the  upper  arch  needed  expanding  in  the  bicuspid 
region  and  that  the  lateral  incisors  should  be  moved  labially 
until  they  were  in  line  with  the  cuspids,  and  that  was  done  in 
this  particular  case. 

Great  care  should  be  exercised  in  adapting  an  expansion 
arch.  For  instance,  where  it  is  desired  to  move  only  the  an- 
terior teeth  and  the  expansion  arch  is  placed  in  position  with  a 


6o  ESSENTIALS    OF    ORTHODONTIA 

slight  spring  toward  the  buccal,  it  will  surely  move  the  anchor 
teeth  buccally  if  worn  for  any  length  of  time.  Likewise,  if  the 
spring  is  in  lingually  the  anchor  teeth  will  move  in  that 
direction. 

In  mounting  anchor  bands  which  are  later  to  recei\'e  the 
expansion  arch,  beginners  often  fail  to  properly  ahgn  the 
tubing  on  the  band  and  later  in  adapting  the  arch  they  will 
bend  it   out  of  shape. 

//  is  better  to  remove  the  anchor  band  and  properly  align 
the  tubing  by  aid  of  the  arch  before  cementing  the  band  to  place. 


EH. A. 


Fig.  76.— Sheath  hook.  Fig.  77. 

(After  Angle.) 

Do  not  spoil  the  expansion  arch  by  bending,  when  the 
trouble  Hes  with  the  incorrectly  placed  tubing.  It  is  far  bet- 
ter to  align  the  tubing  properly  by  resoldering,  besides  being 
the  work  of  only  a  minute.  When  tightening  the  wire  liga- 
tures, place  the  index  finger  of  the  left  hand  on  the  lingual  of 
the  tooth  which  is  Hgated  and  with  the  ball  of  the  thumb  on 
the  expansion  arch  exert  pressure.  The  twisting  of  the  hga- 
ture  must  be  done  at  the  time  pressure  is  being  exerted. 


METHODS    AND    APPLIANCES 


6l 


A  sheath  hook  used  in  connection  with  the  intermaxillary 
appliance  to  engage  the  rubber  elastics  is  shown  in  Fig.  76. 

The  writer's  method  of  utilizing  the  threaded  nut  to  which 
has  been  soldered  a  piece  of  retaining  wire  forming  a  hook  is 
shown  in  Fig.  77.  These  little  sheath  hooks  make  excellent 
attachments  for  the  intermaxillary  elastics,  and  avoid  the 
necessity  of  heating  the  alignment  wire. 

THE  EXPAXSIOX  ARCH  IX  ITS  PRESEXT 
PERFECTIOX 

The  new  appliance  bids  fair  to  revolutionize  orthodontic 
treatment.     It  is  described  by  Dr.  Angle  as  follows:^ 

"The  ideal  principle  in  an  orthodontic  appliance,  that  of 
the  expansion  arch,  is  still  employed,  but  the  arch  now  used  is 
of  necessity  of  much  greater  delicacy  than  the  one  formerly 
employed,  and  it  is  also  further  modified  for  greater  conven- 


FlG.   78. 


-The  middle  and  two  end  sections  of  the  new 
Angle  appliance. 


Fig.  79. 


ience  in  use.  It  is  divided  into  three  sections,  a  middle  and 
two  end  sections.  The  middle  section  is  very  elastic,  is 
smooth,  round,  and  very  delicate  in  size,  being  only  .030  inch 
in  diameter.     It  has  squared  ends  which  accurately  fit  into 

'Angle,  Dental  Cosmos,  Jan.,  IP13. 


62 


ESSENTIALS    OF    ORTHODONTIA 


square  holes  in  the  ends  of  the  threaded  end  sections  (Fig.  78). 
In  operation  the  end  sections  are  shpped  into  the  sheaths  of 
the  anchor  bands  on  the  teeth  used  as  anchorage.  The  middle 
section  is  carefully  bent  so  that  it  will  lie  passively  in  close 
relation  with  the  buccal  and  labial  surfaces  of  the  teeth  in 
their  malpositions,  with  its  ends  telescoping  with  the  threaded 
end  sections  for  about  one-eighth  of  an  inch. 

Instead  of  being  attached  to  the  teeth  to  be  moved  as 
heretofore  by  means  of  wire  ligatures,  bands,  and  spurs,  the 
attachment  of  the  arch  is  now  made  more  direct  and  positive 
by  means  of  delicate  pins  soldered  to  it,  which  engage  delicate 
tubes  soldered  to  bands  on  the  teeth  to  be  moved.  The  pins 
and  tubes  are  shown  in  Fig.   79,  and  the  whole  appliance 


E  H.A, 
Fig.  80.— (After  Angle.) 

(Fig.  80)  is  shown  on  the  upper  dental  arch  of  an  ordinary  case 
belonging  to  Class  I,  which  requires  much  bodily  movement  of 
the  incisors,  with  a  large  amount  of  bone  development. 

Force  is  exerted  on  the  teeth  to  be  moved  by  the  elasticity 
of  the  middle  section  of  the  arch  and  the  pins,  the  middle 
section  being  occasionally  removed  from  the  teeth  and  one  or 
more  of  the  bends  in  it  slightly  straightened,  after  which  it  is 
again  sprung  into  position  on  the  teeth.  This  is  repeated  at 
intervals  until  both  crowns  and  roots  of  the  teeth  have  been 
carried  into  their  normal  positions  in  the  line  of  occlusion. 


METHODS    AND    APPLIANCES  63 

It  will  thus  be  seen  that  the  force  derived  from  the  elasticity  of 
the  arch  and  pins  is  so  distributed  to  the  teeth  that  the  latter 
will  be  carried  bodily,  apices  of  roots  as  well  as  crowns,  in 
the  direction  in  which  force  is  exerted." 

DESCRIPTION  OF  PRACTIC.\L  CASES  TREATED 

Figs.  81  and  82,  right  and  left  side,  respectively,  show  a 
case  of  malocclusion  of  a  young  lady  before  treatment.  Figs. 
87,  and  84  taken  from  photographs  a  few  days  before  treat- 
ment was  begun  clearly  show  the  facial  asymmetry.  The 
lower  arch  being  distal  to  normal  on  the  right  side  only  makes 
this  a  Class  II  case  Division  2  subdivision.  In  all  probability 
this  would  have  been  a  Class  I  case  had  not  her  den- 
tist extracted  the  right  upper  first  bicuspid  at  twelve  years  of 
age,  making  room,  as  he  said,  for  the  cuspid  tooth  to  take  its 
place.  This  inexcusable  act  of  the  dentist  complicated  mat- 
ters a  great  deal,  as  is  so  plainly  to  be  seen  in  the  models  of 
the  finished  case  (Figs.  85  and  86).  While  fairly  good 
occlusion  has  been  gained  in  this  compromise  treatment,  for 
that  in  reality  is  what  it  amounted  to,  since  considerable 
difficulty  was  experienced  in  retaining  the  right  upper  lateral 
incisor  because  of  lack  of  development  in  the  incisal  and  cus- 
pid region,  due  to  loss  of  the  bicuspid  tooth.  Still,  the  writer 
feels  that  he  has  made  a  mistake  and  that  it  would  have  been 
better  to  have  further  expanded  the  upper  arch  and  made 
room  for  an  artificial  first  bicuspid.  Contrast  the  right  and 
left  sides  of  the  models  showing  the  finished  case,  noting  the 
normal  over-bite  on  the  left  side  and  its  sad  lacking  on  the 
right.  Someone  might  ask,  why  was  not  the  over-bite 
lengthened  on  the  right  side  by  bringing  the  cuspid  and  lateral 
further  from  their  sockets?  The  writer  will  answer  by  stating 
that  this  was  done  and  then  retained  for  two  years,  but 
because  of  lack  of  development  and  of  normal  interdigitation, 


64 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  8i. 


Fig.  82. 


Fig.  83. 


Fig.  84. 


METHODS    AND    APPLIANXES 


65 


Fig.  85. 


Fig.  86. 


V 


"■W3^  ■      ..■^wgyg.Hy 


Fig.  87. 


^^^_     -^-■^^^1^ 

J 

^ 

||y^ 

"^^SH||^l' 

^^ 

^p* 

"^ 

^      r 

Fig.  88. 


66  ESSENTIALS    OF    ORTHODONTIA 

through  loss  of  this  one  bicuspid,  these  two  teeth  drifted  back 
into  an  almost  end-to-end  occlusion.  This  inharmony  of 
occlusal  relations  is  plainly  to  be  seen  in  the  photograph 
(front  view)  taken  after  the  case  was  completed  (Fig.  87).  A 
profile  of  the  patient  after  completion  of  treatment  is  shown  in 
Fig.  88.  Front  views  of  the  case  before  and  after  correction 
are  shown  in  Figs.  89  and  90.  Occlusal  views  of  the  case 
before  and  after  tooth  movement  are  shown  in  Figs.  91  and  92. 

Figs.  93  and  94  show  the  right  and  left  sides  of  a  case  of 
malocclusion  of  a  young  man  belonging  to  Class  II,  Division 
I,  compHcated  by  protruding  upper  incisors,  together  with 
torsoversion  of  the  right  upper  second  bicuspid  and  lin- 
guoversion  of  the  left  upper  first  molar.  Figs.  95  and  96 
show  the  right  and  left  sides  of  the  case  immediately 
after  tooth  movement  was  completed  and  just  prior  to  the 
mounting  of  retention  appliances.  Figs.  97  and  98  show 
occlusal  views  of  the  upper  arch  before  and  after  treatment. 

Considerable  difficulty  was  experienced  in  the  rotation 
of  the  upper  second  bicuspid  tooth,  due  to  the  fact  that  the 
patient  was  nineteen  years  of  age  and  also  to  the  malformation 
of  this  particular  tooth.  It  will  be  observed  that  the  lingual 
surface  of  the  right  upper  second  bicuspid  is  presented  toward 
the  buccal,  and  owing  to  the  fact  that  a  much  lesser  tooth 
movement  would  have  to  be  accomphshed  by  making  the 
lingual  surface  serve  for  the  buccal,  and  after  considering  the 
malformation  of  the  cusps  of  the  tooth,  this  was  done. 

By  referring  to  the  occlusal  view  of  the  completed  case 
(Fig.  98)  it  will  be  seen  that  this  bicuspid  tooth  is  in  complete 
torso-occlusion,  the  lingual  surface  presenting  to  the  buccal 
and  the  buccal  surface  to  the  lingual,  the  writer  offering  as 
excuse  for  this  the  reason  cited  above. 

It  might  be  of  interest  to  add  that  the  time  required 
for  the  completion  of  tooth  movement  in  this  case  was  less 


METHODS    AND    APPLIANCES 


67 


.m'SST 

^^^■Hfel^' ^^^^^H 

^j^^jl 

FlC.    Sg. 


Fig.  90. 


Fig.  91. 


Fig.  92. 


Fig.  93. 


Fig.  94. 


68 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  95. 


Fig.  96. 


Fig.  97. 


Fig.  98. 


Fig.  99. 


Fig.  100; 


METHODS    AND    APPLIANCES  69 

than  eight  months,  and  at  this  writing  (five  years  later)  the 
patient  has  written  that  the  teeth  have  retained  their  new 
positions  and  are  entirely  satisfactory  to  him. 

A  rare  case  of  malocclusion  is  shown  in  Fig.  99,  which 
comes  under  Class  I\' ,  the  lower  arch  being  in  distocluslon 
on  the  left  side  and  in  mesioclusion  on  the  right  side. 

Treatment  consisted  in  the  employment  of  the  inter- 
maxillary appliance,  rubber  elastics  being  used  on  the  left 
side  only  at  first.  Later,  rubber  elastics  were  employed  on  the 
right  side,  being  attached  from  the  lower  cuspid  region  to  the 
distal  end  of  the  upper  expansion  arch.  The  result  of  treat- 
ment is  shown  in  Fig.  100. 

An  interesting  case  of  malocclusion  belonging  to  Class  I, 
which  was  caused  by  a  supernumerary  tooth  appearing 
between  the  upper  central  incisors,  is  shown  in  Fig.  loi. 
A  palatine  view  of  the  case  is  shown  in  Fig.  102.  The 
model  here  represented  contains  the  supernumerary  tooth, 
it  having  been  extracted  and  placed  in  the  impression  before 
pouring  with  plaster.  Yery  httle  difticulty  was  experienced 
in  the  treatment  of  this  case.  The  upper  first  molars  were 
used  for  anchor  teeth,  plain  bands  being  placed  on  them,  with 
tubing  on  the  buccal  sides  for  reception  of  the  expansion  arch. 
On  the  left  side  the  nut  was  placed  to  the  distal  of  the  tubing 
on  the  anchor  band,  thereby  pitting  the  resistance  of  all  the 
teeth  on  this  side  in  front  of  the  anchor  band  in  the  movement 
of  the  three  malposed  teeth.  Small  lugs  were  soldered  to  the 
expansion  arch  on  the  left  side  corresponding  to  the  region  of 
the  central,  lateral  and  cuspid  teeth.  Tooth  movement  was 
accomplished  through  the  use  of  rubber  elastic  in  conjunction 
with  wire  ligatures.  The  result  of  treatment  is  shown  in 
Figs.  103  and  104. 

Figs.  105,  106  and  107  show  the  right  and  left  sides  and 
occlusal  view  of  a  case  of  malocclusion  belonging  to  Class  I. 


70 


ESSENTIALS    OF    ORTHODONTIA 


Fig.   ioi. 


Fig.  I03 


Fig.  103. 


Fig.  104. 


I'lG.     105. 


Fic.   ic6. 


METHODS    AND    APPLIANCES 


Fig.   loq. 


Fk;.    1 10. 


Fig.   III. 


Fig.   112. 


72  ESSENTIALS    OF    ORTHODONTIA 

Although  there  was  slight  mesioclusion  on  the  left  side,  after 
labial  movement  of  the  incisors  was  accomplished,  so  that  an 
over-bite  was  established,  occlusion  shifted  on  this  side  without 
further  treatment.  The  result  is  shown  in  Figs.  io8,  109  and 
no.  In  Figs.  Ill  and  112  occlusal  views  are  shown  after 
tooth  movement  was  accomplished. 

Fig.  113  represents  the  model  of  a  case  of  very  marked 
malocclusion.  The  patient  suffering  with  this  anomalous 
condition  was  referred  to  a  specialist  in  cleft-palate  work  by  a 
dentist  who  thought  from  the  speech  of  the  patient  that  he  was 
suffering  from  a  cleft  palate.  He  was  finally  referred  to  the 
writer,  but  on  account  of  the  fact  that  he  was  twenty-five  years 
of  age,  no  treatment  was  undertaken. 

This  is  the  most  marked  case  of  irregularity  that  the  writer 
has  ever  seen  on  record.  The  possessor  of  this  abnormal  con- 
dition presented  no  other  signs  of  physical  defects. 

Figs.  114  and  115  show  the  right  and  left  sides,  respec- 
tively, of  a  case  of  malocclusion  belonging  to  division  of  Class 
III,  complicated  by  torsoversion  of  the  upper  lateral  incisors. 
The  models  were  photographed  with  the  two  expansion  arches 
in  position  (which  constitutes  the  intermaxillary  appliance) 
in  order  to  show  the  method  employed  in  the  treatment  of  this 
case. 

Note  the  position  of  the  spurs  soldered  to  the  expansion 
arch  on  the  lower  model.  Rubber  elastics  were  engaged  to 
these  spurs  and  hooked  over  the  distal  ends  of  the  expansion 
arch  on  the  upper. 

Rotation  of  the  upper  laterals  was  accomplished  by  means 
of  bands  with  spurs  soldered  on  the  lingual  to  engage  wire 
ligatures. 

Figs.  116  and  117  show  two  views  of  the  case  after  retaining 
appliances  were  mounted  in  position.  Notice  that  retention 
is  accompHshed  in  this  case  by  use  of  six  bands.     The  bands 


METHODS    AND    APPLIANCES 


73 


Fig.  113. 


Fig.  114. 


Fig.  115. 


Fig.  116. 


Fig.  117. 


74 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  ii8. 


Fig.  119. 


Fig.  120. 


¥u..   121. 


Fig.  122. 


Fig.  123. 


METHODS    AND    APPLIANCES 


75 


on  the  four  first  molars  have  spurs  soldered  on  the  buccal,  and 
through  the  reciprocating  force  thus  exerted  the  arches  are 
held  in  their  new  relations.  The  retaining  bands  on  the  later- 
als have  spurs  soldered  so  as  to  engage  the  labial  surfaces  of 
the  cuspids  and  lingual  surfaces  of  the  centrals.  It  is  now 
considered  better  practice  to  use  the  round  wire  for  retaining 
lugs  as  there  is  less  tooth  structure  in  contact  with  the  lug 
than  in  the  old  form  of  clasp  metal. 

Figs.  ii8,  119  and  120  show  the  right  and  left  sides  and 
front  view,  respectively,  of  a  case  of  malocclusion  belonging 
to  Class  I  (Angle  Classification).     This  is  a  typical  case  of 


Fig.  124. 


Fig.  12.V 


Class  I  as  both  upper  and  lower  first  molars  (the  keys  to 
occlusion)  are  in  normal  mesio-distal  relations.  The  right 
upper  second  bicuspid  is  in  linguoversion,  while  the  first 
bicuspid  is  in  buccoversion.  The  anterior  view  shows  the 
crowded  condition  and  torsoversion  of  the  four  upper  incisors. 
Treatment  consisted  in  the  employment  of  expansion 
arches  adapted  to  both  upper  and  lower  arches.  Tooth 
movement  was  first  begun  in  the  upper  arch,  preceding  the 
fitting  of  an  expansion  arch  to  the  lower  teeth  by  some  there 


76  ESSENTIALS    OF    ORTHODONTIA 

or  four  weeks.  The  four  upper  incisors  were  banded,  with 
small  lugs  soldered  to  the  lingual  surfaces  of  the  bands  for  the 
purpose  of  engaging  the  wire  ligatures  used  in  their  rotation. 

Tooth  movement  progressed  very  rapidly,  despite  the 
fact  that  the  patient  was  past  twenty-two  years  of  age. 

Figs.  121,  122  and  123  show  the  right  and  left  sides  and 
front  view  of  the  case  after  tooth  movement  was  accomplished. 
Far  better  occlusion  would  have  been  gained  had  the  case  not 
been  complicated  by  the  extraction  of  the  right  lower  lateral 
incisor  early  in  life. 

Figs.  124  and  125  show  occlusal  views  of  the  lower  arch 
before  and  after  tooth  movement.  These  views  are  shown  for 
the  purpose  of  illustrating  the  method  of  retaining  the  lower 
incisors,  and  that  of  substituting  a  right  lower  lateral  incisor 
for  this  missing  tooth.  The  patient  was  a  student  of  the 
writer's  and  he  objected  to  a  bridge  whereby  the  pulp  in  at 
least  one  tooth  would  have  to  be  sacrificed.  The  plan  finally 
agreed  upon  consisted  in  the  making  of  a  gold  band  on  the 
lower  cuspid,  being  pinched  together  on  the  lingual  surface 
in  the  usual  way.  To  this  band  was  soldered  a  lateral  facing 
having  a  spur  which  rested  against  the  lingual  surface  of  the 
central  incisor.  The  model  shown  in  Fig.  125  is  from  an 
impression  taken  three  years  after  completion  of  the  case. 


CHAPTER  VIII 

RETENTION 

The  frequently  asked  question,  "How  long  should  retain- 
ing appliances  be  worn?"  can  never  be  definitely  answered. 
The  occlusion  gained  in  the  movement  of  malposed  teeth  plays 
the  most  important  part  in  the  time  required  for  the  retain- 
ing appliances  to  remain  in  position.  Of  course  the  obstacles 
to  overcome  in  tooth  movement,  age  and  health  of  the  patient, 
etc.,  are  to  be  reckoned  with.  In  no  other  phase  of  Orthodon- 
tia work  is  the  constructive  ingenuity  of  the  operator  taxed  so 
much  as  in  the  mounting  of  proper  retaining  appliances. 
Retention  appliances  must  possess  stability,  and  yet  should  be 
as  inconspicuous  as  possible.  After  normal  occlusion  is 
established  for  a  short  while,  a  great  number  of  patients  seem 
to  forget  that  they  ever  suffered  with  malocclusion,  and  ask  to 
have  the  retaining  appliance  removed  soon  after  it  is  cemented 
in  position.  Ofttimes  these  appliances  are  removed  too 
early,  before  sufiicient  development  has  taken  place,  with 
the  consequence  that  the  teeth  quickly  return  to  their  old 
positions.  Caution  should  be  used  after  the  removal  of 
retaining  appliances.  These  appliances  should  not  be  de- 
stroyed after  removal,  but  laid  away  in  a  convem'ent  place  and 
the  patient  seen  regularly  to  note  if  there  is  any  tendency  of 
the  teeth  to  return  to  their  old  malposition;  for  in  this  way 
only  can  you  be  sure.  Exceptions  to  this  rule  may  arise  in 
non-complicated  cases  where  a  single  inlocked  upper  incisor 
has  been  moved  out  into  its  proper  position.  In  such  cases 
the  normal  over-bite  in  occlusion  is  sufficient  to  retain  the  tooth 

77 


7  8  ESSENTIALS    OF    ORTHODONTIA 

without  the  use  of  a  retaining  band,  providing  the  regulating 
apparatus  has  been  allowed  to  remain  in  position  after  tooth 
movement,  until  all  soreness  has  disappeared.  Figs.  135,  136, 
137  and  138  show  successful  methods  of  retaining  certain  cases. 
Intermaxillary  reciprocating  buccal  spurs  are  shown  in 
Fig.  139.  In  removing  bands  where  it  is  desirable  to  keep  the 
appliance  intact  for  possible  future  use,  especially  retention  ap- 
pliances, a  good  method  is  to  roll  a  napkin  up  tightly  and  place 
it  on  the  occlusal  or  incisal  of  the  banded  tooth,  then  place 
one  beak  of  a  flat-nose  phers  on  the  napkin,  working  the  oppo- 
site beak  over  the  edge  of  the  band  at  the  cervical  and  with 
slight  pressure  the  band  can  be  loosened.  Then  by  alter- 
nately changing  from  buccal  to  lingual  the  band  can  be 
removed  without  distortion  and  with  even  less  danger  of 
scratching  the  enamel  of  the  tooth  than  where  band  slitters 
or  band-removing  pliers  are  employed.  Bands  and  retainers 
removed  in  this  way  can  be  sterilized  and  placed  in  an  envel- 
ope on  which  is  written  the  patient's  name  and  date  of 
removal.^ 

TECHXIC  COURSE 

Junior  students  will  be  required  to  construct  the  following 
illustrated  parts,  which  constitute  the  technic  course  in 
Orthodontia. 

In  advancing  the  Technic  Course  to  the  junior  class,  it  is 
with  the  intention  that  the  student  become  familiar  with  the 
construction  and  mounting  of  appliances  that  he  may  the 
better  be  enabled  to  take  care  of  a  practical  case  which  he  is 
later  to  receive.  The  technic  exercises  will  be  assigned  to  the 
class  one  at  a  time,  and  it  is  expected  that  this  particular 
piece  of  technic  will  be  finished  and  handed  to  the  teacher  for 

^  There   are   special   pliers  made  for  the  purpose  of  removing  bands,  but  the 
method  described  above  is  used  with  preference  by  the  writer. 


RETENTION  79 

his  acceptance  or  rejection  before  another  exercise  is  given  to 
the  class  in  the  course  of  a  week  or  so,  as  announced.  This  is 
not  for  the  purpose  of  rushing  matters  at  all,  but  is  rather  for 
the  student's  good,  since  if  the  technic  construction  is  put  off 
until  the  eleventh  hour,  so  to  speak,  he  will  do  it  in  a  hurried, 
haphazard  way,  failing  utterly  to  get  the  benefit  for  which  the 
course  is  intended. 

Exercise  No.  i.  Take  an  Impression  and  Trim  a  Model. 
— Models  secured  from  the  impression  of  dies  will  not  be 
accepted,  for  they  are  unsuited  to  this  work.  Probably  the 
best  way  would  be  to  take  an  impression  of  a  fellow  student's 
mouth;  obtaining  a  model  in  this  way  gives  practical  experi- 
ence in  a  convenient  way,  for  no  student  who  is  interested  in 
the  work  will  refuse  to  have  his  impression  taken.  Pour  the 
impression  and  trim  the  model  as  shown  in  Fig.  51. 


Exercise  No.  2.  Soft  Soldering. — Select  a  piece  of  spur 
wire,  16  gauge,  3  inches  in  length;  with  soft  solder  unite  three 
loops  of  ligature  wire  No.  26  gauge  shown  at  "A"  in  Fig.  126. 
Then  unite  to  the  spur  wire  an  end  of  a  ligature  wire  shown  at 
"B,"  and  cut  it  about  one-thirty-second  of  an  inch  long.  This 
operation  is  repeated  until  you  have  the  three  short  spurs  as 
shown  above.  Next,  take  a  piece  of  spur  wire,  18  gauge,  and 
soft-solder  one  end  to  the  main  wire  shown  at  "  C,"  and  cut  it 
about  one-sixteenth  of  an  inch  long.  This  is  repeated  until 
you  have  the  three  spurs  shown  above.  By  the  use  of  these 
heavier  spurs,  attachments  are  afforded  for  intermaxillary 
elastics  in  connection  with  alignment  wires.     Use  very  small 

Note. — The  drawing   illustrating  the  technic  exercises  were  made  by  student 
Willis  G.  Pieck,  Class  of  191 5,  O.  C.  D.  S. 


8o 


ESSENTIALS    OF    ORTHODONTIA 


pieces  of  solder  in  all  of  these  attachments,  as  very  little  is 
required.  Avoid  an  excess  of  heat.  This  is  important,  for 
it  is  desirable  to  retain  the  temper  in  the  main  spur  wire.  The 
technic  piece  should  now  be  carefully  polished  and  mounted 
on  a  piece  of  cardboard,  on  which  is  written  the  student's 
name. 

Exercise  No.  3.  Hard  Soldering. — A  good  exercise  in  the 
use  of  silver  solder  is  shown  in  the  illustration  below  (Fig.  127). 
Take  a  piece  of  spur  wire,  16  gauge,  shown  at  "A"  below;  then 
unite  the  piece  of  spur  wire,  No.  18  gauge,  shown  at  "B  "  in  the 
illustration.  Repeat  this  until  you  have  the  four  spurs  sho\\Ti 
below.     Each  succeeding  attachment  is  cut   slightly  longer 


Fig.  127. 


than  the  one  previoush'  united.  They  should  be  made  from 
long  pieces  of  spur  wire  and  cut  to  accurate  lengths  after 
soldering.  They  should  be  arranged  in  pairs,  though  each 
attachment  is  soldered  on  separately.  The  student  will 
find  it  a  difficult  and  interesting  procedure  to  unite  the  last 
attachment  of  any  one  of  the  pair,  but  the  experience  gained 
will  be  of  great  benefit  in  the  exercises  which  follow  and  in  the 
construction  of  appliances  later,  especially  in  the  soldering  of 
pins  whenever  the  new  Angle  appliance  is  used.  After  solder- 
ing'^the  attachments  and  cutting  them  to  accurate  lengths, 
round  the  ends  with  a  file  or  sandpaper  disc.  Mount  the 
technic  piece  on  cardboard,  as  indicated  in  the  previous 
exercise. 


RETENTION 


8l 


Exercise  No.  4.  Band  Construction. — This  technic  exer- 
cise in  band  construction  consists  of  a  plain  band  adapted  to  an 
upper  central  or  lateral  incisor  (Fig.  128) .  In  the  movement  of 
individual  malposed  teeth,  some  form  of  secure  attachment  is 
necessary  in  the  majority  of  cases  for  the  accurate  movement 
into  Hne  of  occlusion.  This  exercise  has  a  great  range  of 
usefulness,  as  will  be  seen  later  in  the  application  of  appli- 
ances. Properly  constructed  bands  are  the  fundamental 
requirement  in  the  application  of  any  regulating  or  retaining 
appliance.  Plain  bands  should  have  as  nearly  perfect  adapta- 
tion to  the  teeth  upon  which  they  are  placed  as  it  is  possible 
to  obtain.     The  use  of  the  band-forming  pliers  is  absolutely 


A  y 


Fig.  128. 

essential  in  the  construction  of  any  plain  band.  The  band 
material  is  pinched  or  drawn  together  on  the  lingual  surface  of 
the  tooth,  locating  the  seam  on  the  lingual  surface.  After  sol- 
dering, the  excess  band  material  is  cut  away  and  the  joint  care- 
fully polished  in  order  not  to  interfere  with  the  tongue.  Do 
not  take  the  measure  of  a  tooth  and  attempt  to  construct  a 
hand  from  the  measurement  taken.  Use  the  vulcanite  technic 
model  for  the  making  of  all  plain  bands.  Place  the  band  metal 
around  the  tooth  on  the  model  and  draw  together  on  the  ling- 
ual side  with  the  band-forming  pliers,  which  is  very  similar 
to  working  conditions  met  with  in  the  mouths  of  patients. 


82 


ESSENTIALS    OF    ORTHODONTIA 


Fig.  i2g. 


Fig.   130. 


B 


Fig.  131. 


RETENTION  83 

Exercise  No.  5. — This  exercise  in  band  construction  is 
similar  to  the  previous  exercise,  except  that  a  groove  or  notch 
is  formed  at  the  seam  on  the  Hngual  surface  of  the  band.  This 
is  done  b}'  leaving  an  excess  when  cutting  away  the  surplus 
band  metal,  and  with  a  file,  a  notch  is  formed  in  the  center 
of  the  band  through  the  seam  shown  at  ''A"  (Fig.  129). 
This  groove  affords  secure  attachment  for  wire  ligatures  or 
rubber  elastics  in  the  labial  or  buccal  movement  of  teeth  that 
are  in  linguoversion.  Pickle  and  carefully  polish  the  band 
after  soldering,  making  sure  that  the  edges  of  the  seam  shown 
at ''  B  "  are  smooth  in  order  to  prevent  irritation  of  the  tongue. 

Exercise  No.  6. — This  exercise  consists  of  a  plain  band 
fitted  to  an  upper  central  or  lateral  incisor  on  the  technic 
model.  Upon  the  mesio-lingual  or  disto-lingual  border,  well 
toward  the  cervical,  solder  a  spur  which  inclines  toward  the 
median  line,  forming  an  acute  angle  with  the  lingual  surface 
''A"  (Fig.  130).  The  spur  should  be  made  of  No.  16  gauge 
wire  and  cut  to  correct  length  after  soldering.  This  form  of 
attachment  to  a  plain  band  is  useful  in  rotating  teeth  that  are 
in  torsoversion.  In  soldering  the  spur  be  careful  to  confine  the 
heat  to  the  area  to  be  soldered ;  otherwise  there  will  be  danger 
of  opening  the  joint  of  the  band.  The  spur  should  be  rounded 
and  polished. 

Exercise  No.  7. — This  exercise  consists  of  a  plain  band 
fitted  to  an  upper  first  or  second  bicuspid,  with  spurs,  on  the 
lingual  and  buccal  sides  as  shown  at  ''A"  and  "B"  (Fig.  131). 
The  spurs  should  incline  in  opposite  directions  in  order  that 
attachments  can  be  had  for  a  pushing  and  pulling  movement, 
which  is  sometimes  desirable  for  the  forcible  rotation  of  these 
teeth.  The  spurs  are  made  from  18  gauge  wire.  The  seam 
of  the  band  should  be  on  the  lingual  surface,  near  the  mesial 
or  distal  surface,  according  to  the  location  of  the  lingual  spur. 
This  is  to  permit  the  soldering  of  the  spur  without  opening  the 


84  ESSENTIALS    OF    ORTHODONTIA 

joint.  A  band  of  this  kind  permits  of  the  use  of  a  threaded 
bar  or  jackscrew  anchored  on  the  buccal  surface  of  the  molar, 
and  an  elastic  ring  on  the  lingual  surface,  or  vice  versa,  as  the 
case  may  require.  The  ends  of  the  spurs  should  be  carefully 
rounded  and  polished. 

Exercise  No.  8. — This  problem  shows  a  method  of  attach- 
ment for  distal  movement  of  cuspids.  The  seam  is  located  as 
usual  on  the  lingual  surface.  A  piece  of  seamless  tubing 
about  one-eighth  of  an  inch  long,  and  Xo.  i6  gauge  bore,  is 
soldered  near  the  cervical  border  of  the  band  on  the  distal 
surface  (Fig.  132).  This  affords  attachment  for  a  retraction 
screw  which  is  very  efficient  for  distal  and  lingual  movement  of 
cuspids  that  are  in  labial  and  mesial  prominence.  Owing  to 
their  subjection  to  hea\y  strain  these  little  tubes  should  be 
well  soldered,  but  care  must  be  taken  to  prevent  solder  from 
flowing  into  the  inner  side  of  the  tube.  This  can  be  avoided 
by  preventing  flux  from  entering  the  inner  side  of  the  tube,  or 
by  placing  a  little  antiflux  in  the  inner  side  of  the  tube.  A 
small  amount  of  solder  evenly  flowed  is  better  than  a  large 
amount  unevenly  flowed. 

Exercise  No.  9. — The  problem  illustrated  (Fig.  133)  con- 
sists of  a  plain  band  adapted  to  an  upper  central  incisor.  The 
band  metal  in  this  instance  is  drawn  or  pinched  together  on  the 
labial  surface  of  the  tooth,  thereby  locating  the  seam  in  the 
median  line  of  the  labial  surface.  The  joint  should  be  well  sol- 
dered and  an  excess  of  about  one-sixteenth  of  an  inch  left  in  cut- 
ting away  the  excess  band  metal.  A  notch.  A,  is  then  cut  in  the 
projection  of  the  band  metal  at  the  seam  similar  to  the  exercise 
illustrated  in  Fig.  129.  This  notch  is  for  the  reception  of  an 
alignment  wire,  and  its  size  should  correspond  to  the  gauge  of 
the  alignment  wire  used,  which  in  the  majority  of  cases  is  made 
of  No.  16  gauge  wire.  This  band  is  useful  in  the  lingual  move- 
ment of  central  incisors  that  are  protruding;  also  for  the 


RETENTION 


Fig.  134. 


Fig.  135. 


86  ESSENTIALS    OF    ORTHODONTIA 

extrusion  in  cases  of  open-bite  malocclusion.  The  incisal 
and  cervical  ends  should  be  well  rounded  and  smoothed  in 
order  to  prevent  irritation  of  the  lips,  as  shown  at  B. 

Exercise  No.  lo. —  In  this  problem  another  method  of 
providing  a  groove  or  notch  for  the  reception  of  an  alignment 
wire  is  shown  (Fig.  134).  This  exercise  consists  of  a  plain 
band  with  the  joint  formed  on  the  lingual  surface  in  the  usual 
w^ay.  Two  spurs  are  then  soldered  on  the  labial  surface  of  the 
band  in  the  median  line,  shown  at  A,  being  separated  the 
distance  of  the  diameter  of  an  expansion  arch.  This  is  best 
done  by  bringing  an  expansion  arch  in  contact  with  the  labial 
surface  of  the  band,  while  the  band  is  in  position  on  the  tooth, 
and  marking  with  a  pointed  instrument  on  the  cervical  and 
incisal  borders  of  the  band.  The  spurs  are  then  soldered, 
using  18  gauge  wire.  The  length  of  the  spurs  should  also 
correspond  to  the  diameter  of  the  expansion  arch  and  should 
be  well  rounded  and  smoothed. 

Exercise  No.  11.  Construction  of  Retaining  Bands. — In 
the  previous  exercises  the  bands  constructed  have  been  for  the 
purpose  of  aiding  in  the  accomplishing  of  tooth  movement. 
It  is  now  well  to  consider  the  construction  of  bands  with 
attachments,  which  will  retain  the  teeth  after  the  desired  tooth 
movement  has  been  gained.  Construct  a  plain  band  in  the 
usual  way  and  solder  two  spurs,  one  on  the  labial  and  one  on 
the  lingual  surface  of  the  band.  The  spurs  should  be  of 
sufficient  length  to  engage  the  approximating  teeth,  on  their 
labial  and  lingual  surfaces,  shown  at  A  and  B,  Fig.  135.  The 
spurs  are  made  from  No.  18  gauge  wire.  A  band  with  spurs 
soldered  in  this  way  would  prevent  an  incisor  that  has  been 
rotated  from  returning  to  its  old  malposition.  In  the  reten- 
tion of  teeth  the  resistance  offered  must  be  constant  and 
unvarying.  The  band  here  illustrated  makes  an  ideal  retainer 
for  a  tooth  that  has  been  rotated.     Teeth  that  have  been 


RETENTION 


87 


rotated  require  a  longer  period  of  retention  than  for  labial  or 
lingual  movements. 

Exercise  No.  12. — After  elimination  of  an  abnormal  space 
between  the  central  incisors,  shown  at  A  in  the  illus- 
tration below  (Fig.  136)  a  retainer  is  provided  as  shown  below 
at  B.  This  exercise  consists  of  two  plain  bands  made  in  the 
usual  way,  and  having  their  mesial  approximating  surfaces 
united  with  solder.     Notice  that  the  union  of  the  bands  should 


Fig.  136. 


Fig.  137. 


be  near  their  incisal  borders.  Very  little  solder  is  required 
for  the  uniting  of  the  bands,  and  they  should  be  accurately 
aligned  before  soldering  in  order  to  permit  of  ease  in  applica- 
tion and  cementation. 

Exercise  No.  13. — The  retaining  appliance  here  shown 
(Fig.  137)  consists  of  two  plain  bands  adapted  to  the  cuspids 
and  united  with  a  lingual  bar  of  spur  wire,  No.  18  gauge,  shown 
at  A  above.     This  form  of  retaining  appliance  is  very  effective 


88  ESSENTIALS    OF    ORTHODONTIA 

for  the  retention  of  cuspids  that  have  been  rotated,  especially 
lower  cuspids.  It  also  forms  a  good  retainer  for  the  four  incis- 
ors that  have  been  moved  labially.  Such  a  retainer  is  also 
shown  appHed  to  the  upper  arch  in  Fig.  138,  the  bar  resting 
against  the  lingual  surfaces  of  the  incisors,  preventing  their 
return  to  positions  of  linguo version. 

Exercise  No.  14. — An  entirely  different  form  of  retainer 
is  here  shown.  It  consists  of  a  rather  wide,  plain  band,  adapted 
to  a  lower  cuspid  tooth,  with  an  inclined  spur  soldered  on  the 
labial  surface  of  the  band  A,  Fig.  139.  The  spur  is  so  placed 
that  its  distal  incline  opposes  the  mesio-incisal  surface  of  the 
upper  cuspid.  This  maintains  normal  arch  relation  and  is  used 
after  the  shifting  of  occlusion  in  Class  II.  Two  bands  used 
in  combination  on  the  first  molars,  upper  and  lower,  shown  at 
B,  Fig.  139,  also  afford  good  retention  after  correction  of  arch 
malrelation  in  cases  of  Class  II  and  Class  III.  The  spurs 
should  be  so  placed  that  the  inclined  planes  oppose  each 
other  in  occlusion,  the  manner  in  which  they  oppose  each 
other  depending  on  the  direction  in  which  the  occlusion  has 
been  shifted. 

Exercise  No.  15. — Construct  anchor  bands  and  adapt 
alignment  wire  to  vulcanite  model  of  malposed  teeth,  as  illus- 
trated in  Figs.  140  and  141.  The  advantages  of  constructing 
an  appliance  on  such  a  model  is  readily  apparent,  since  the 
bands  can  be  brought  together  on  the  lingual  surface  of  the 
anchor  teeth,  and  incisors  also,  by  use  of  the  band-forming 
pliers,  practically  the  same  as  working  in  the  mouth.  The 
only  correct  method  0]  constructing  hands  for  ortJiodontic  purposes 
is  to  form  them,  around  the  teeth  in  the  hioiith.  The  vulcanite 
model  permits  of  similar  working  conditions  as  found  in  the 
mouth,  and  should  give  the  student  a  good  idea  of  conditions 
which  he  will  meet  with  later  in  practice.  The  bending  of  the 
expansion  arch  should  always  be  with  the  fingers.     Never 


RETENTION 


89 


Fig.  138. 


Fig.  139. 


Fig.  140* 


Fig.  141. 


go  ESSENTIALS    OF    ORTHODONTIA 

use  the  pliers  for  this  purpose.  A  great  deal  of  care  is  essen- 
tial to  the  correct  adaptation  of  the  expansion  arch,  for,  as 
previously  stated,  the  teeth  will  align  to  the  bent  form  of 
the  expansion  arch. 

LIST  OF  INSTRUMENTS  AND   :^IATERL\LS 

Before  attempting  the  correction  of  malocclusion,  it  is 
necessary  to  have  special  instruments  and  materials  for  the 
construction  of  various  parts  of  an  orthodontic  appliance. 

The  use  of  instruments  and  materials  should  here  become 
an  object  of  special  study  by  the  student. 

A  mouth  mirror  (Fig.  142)  and  explorer  are  indispensable 
for  the  careful  examination  of  the  mouth  and  teeth  before 
beginning  orthodontic  treatment. 

A  rubber  plaster  bowl  of  medium  size  (Fig.  143)  for  mixing 
plaster.  A  large  glass  slab,  on  which  the  impression  is  in- 
verted after  pouring. 

A  large  square  end  plaster  spatula  (Fig.  144)  should  be  used 
in  mixing  the  plaster. 

A  set  of  special  impression  trays  (Figs.  40  and  41)  is  essen- 
tial in  order  to  obtain  good  impressions.  They  should  be 
kept  neat  and  clean.  A  fixed-blade  plaster  knife  for  the 
trimming  of  the  model  is  shown  in  Fig.  145. 

The  two  plaster  knives  shown  in  Figs.  146  and  147  are  very 
useful  for  groo\-ing  and  removing  plaster  impressions. 

For  accurate  trimming  of  models,  a  try-square  is  useful. 
The  plaster  plane  (Fig.  148)  for  the  artistic  trimming  and  pro- 
portioning of  the  model  completes  the  list  of  plaster  instru- 
ments. A  blo\\pipe  (Fig.  60)  designed  especially  for  the 
purpose  is  absolutely  necessary  for  soldering  delicate  parts  of 
an  appliance.  A  small  Bunsen  burner  (Fig.  59)  for  soldering 
bands.     Band-forming  pliers  (Fig.    149)   are  essential.     The 


RETENTION  9 1 

writer's    modification   of   band-forming   pliers  is   shown   in 
Figs.  150  and  151. 

Band-soldering  pliers  asshownin  Fig.  152  are  indispensable. 


Fig.  142. 

The  points  of  these  pliers  are  bent  at  right  angles,  which  allow 
the  flame  to  pass  around  the  joint,  thus  allowing  the  solder 
to  flow  easily  without  overheating  the  band. 

Solder  tweezers  (Fig.  154)  for  holding  and  placing  small 
pieces  of  solder. 

Wire  nippers  (Fig.  155)  for  cutting  off  the  ends  of  the 
alignment  wire,  spur  wire,  etc. 


92  ESSENTIALS    OF    ORTHODONTIA 

Flat-nose  and  laboratory  pliers  (Figs.  156  and  157)  for 
twisting  the  ligatures. 

Locking  tweezers  (Fig.  158)  for  holding  bands  while  the 
sheaths  or  spurs  are  realigned. 

Plate  shears,  small  size,  straight  pattern  (Fig.  159)  for 
cutting  band  material  and  solder. 

Plate  shears,  small  size,  curved  pattern  (Fig.  160)  for 
cutting  ligature  wire. 


Fig.  143. — ^Medium  size  plain  bowl. 

Band  driver  and  small  mallet  (Figs.  161  and  162)  for  forc- 
ing the  band  to  place. 

Wrench  for  manipulation  of  nuts  of  an  expansion  arch  is 
shown  in  Fig.  163. 

Ligature  wire  for  the  ligating  of  malposed  teeth  is  shown 
in  Fig.  164.     Spool  of  ligature  silk. 

A  small,  half  round,  smooth  cutting,  metal  file,  for  the 
finishing  of  spurs,  etc. 

A  burnisher,  of  the  double  end  design  (Fig.  165)  is  used  in 
adapting  the  bands  accurately  to  the  teeth. 

A  shallow,  saucer-shaped  glass  dish  with  cover  (Fig.  166) 
for  holding  small  pieces  of  solder  and  flux. 

A  cement  spatula  (Fig.  167)  and  large  glass  slab. 

A  round  sable  hair  brush,  small  size,  for  application  of 
flux  in  soldering. 


RETENTION 


93 


94 


ESSENTIALS    OF    ORTHODONTIA 


RETENTION 


95 


Yic,.  150.— The  author's  band-formins  pUers. 


Pj^;.   151.— Another  view  of  the  author's  band-forming  pliers 


Fig.  152.— Band-soldering  pliers. 


Fig.  153. — Solder  tweezers.     Small  size. 
Fig.   154.— Solder  tweezers.     Medium  size. 


96 


ESSENTIALS    OF    ORTHODONTIA 


RETENTION^ 


97 


fi^ 


98 


ESSENTIALS    OF    ORTHODONTIA 


A  small  solarization  case  for  pickling. 

One  piece  of  silver  solder,  easy  flowing  5  dwt. 

Package  of  jeweler's  soft  solder. 


Fig.  159. — Small  size  plate  shears. 


Fig.  160. — Plate  shears  (curved). 


Fig.  161. — Band  driver. 


Package  of  crystal  borax. 

Four   ounces   of  dilute   sulphuric   acid,   to   be   used   for 
pickling  bands  after  soldering. 


RETENTION 


99 


lOO 


c 


ESSENTIALS    OF    ORTHODONTIA 

Two  or  three  coils  of  nickel  silver  band 
material,  live-thirty-seconds  of  an  inch  wide 
and  No.  36  gauge. 

Three  or  four  pieces  of  No.  18  gauge 
nickel  silver  alloy  wire,  for  spurs,  etc. 

One  piece  of  nickel  silver  alloy  seamless 
tubing.  No.  16  gauge  bore. 

One  piece  of  nickel  silver  alloy  square 
bar,  for  the  construction  of  inclined  spurs. 

Ten  dwt.  nickel  silver  plate  34  gauge 
for  anchor  band  construction. 

Box  of  separating  rubber  strips,  assorted 
sizes. 

Assortment  of  expansion  arches. 

One  box  of  napkins  and  assorted  cotton 
rolls. 

One  box  of  cement. 


fl 


I 


I 


Fig.   166. — Glass  dish. 


INDEX 


Accidents,  a  cause  of  malocclusion,  2 1 
Alignment,  definition  of,  2 

wire,  9 
Anchor  bands,  1 1 
Anchorage,  definition  of,  8 

extramaxillary,  9 

intermaxillary,  8 

intramaxillary,  9 

occipital,  9 

reciprocal,  10 

reinforced,  10 

secondary,  9 

simple,  9 

stationary,  9 
Angle's  classification,  20 
Appliances,  45,  57 

choice  of  metals,  45 

efficiency  of,  47 

materials  for  construction  of,  47 
Arch,  4 

alveolar,  4 

constricted,  8 

dental,  4 

dome  of  the,  4 

expansion,  9 

gothic,  8 

integrity,  preservative  force  of,  10 

malrelation  of,  4 

predetermination  of,  6. 

saddle-shaped,  8 
Articulation,  definition  of,  10 

Bands,  45 

adjustable,  45 

construction  of,  81 

plain,  45 

retaining,  86 

securing  of  space  for,  47 
Band-making,  45 


Bilateral,  5 

infra-occlusion,  6 
Bi maxillary,  5 

infra-occlusion,  6 
Buccal  occlusion,  8 
Buccoversion,  12 

Cast,  5 
Classification,   12,  18 

Angle's,  18 

Lischer's,  12,  20 
Clay  model  of  the  face,  32 
Close-bite  malocclusion,  3 
Constricted  arch,  8 
Contrude,  5 

Delayed  eruption  of  permanent  teeth, 

21 
Dental  orthopedia,  i 

zones,  4 
Dento-facial  area,  2 

orthopedia,  2 

relation,  2 
Development,  regional,  10 
Developmental  spaces,  10 
Distal  occlusion,  8 
Distoclusion,  13 
Distoversion,  12 
Dome  of  the  oral  arch,  4 

Early  loss'of  deciduous  teeth,  2 1 
Etiology-,  21 
Exercises,  technic,  78 
Expansion  arch,    10 

adaptation  of,  59 

alignment  of,  59 

application  of,  54 

plain,  57 

ribbed,  58 


I02 


INDEX 


Expansion  arch,  sheath  hooks  for,  60 

the  new  angle,  61 

uses  of,  57 
Extramaxillary  anchorage,  10 
Extrude,  15 

Facial  art,  32 

asymmetry,  11 
symmetry,  1 1 

Gnathia,  definition  of,  13 
Gothic  arch,  8 

Habits,  21 
Hard  soldering,  80 
Harmony  of  facial  profile,  32 
Hyperplastic  formation  of  connective 
tissue,  12 

Imperfect  fillings  and  crowns,  21 
Impression,  38 

assembling  of,  41 

filling  the,  42 

material  for,  38 

method  of  removing,  41 

modeling  compound,  38 

plaster,  39 

trays,  38 
Incisors,  labial  movement  of,  63 

lingual  movement  of,  66 
Infra  version,  12 
Infra-occlusion,  5 
Inharmony  of  the  facial  profile,  32 
Instruments,  list  of,  66 
Interdigitate,  3 
Interdigitation,  3 
Intermaxillary  anchorage,  8 

appliance,  9 

buccal  spurs,  78 
Intramaxillary  anchorage,  9 
Irregularity,  2 

Jack  screw,  9 

application  of,  55 

Key  to  occlusion,  7 


Labial  occlusion,  8 

Labioversion,  12 

Ligatures,  method  of  tightening,  60 

Linguoversion,  12 

Line  of  occlusion,  7 

Lischer's  classification,  12 

List  of  instruments,  89 

Long  bite  malocclusion,  4 

Loss  of  permanent  teeth,  21 

Malalignment,  2 
Maleruption,  4 
Malformation  of  the  jaw,   12 

macrognathism,  12 

micrognathism,  12 
Malocclusion,  7 

open-bite,  7 

close-bite,  3 

short-bite,  3 
Malposed,  2 

Malrelation  of  the  arches,  13    - 
Malturned,  4 
Mandibular  retroversion,  6 

anteversion,  6 
Materials,  list  of,  89 
Mesial  occlusion,  8 
Mesioversion,  12 
Methods  and  appliances,  57 
Metals  for  construction  of  appliances, 

47 

Method  of  removing  bands,  78 
Model,  5 

trimming  of,  42 

importance  of  accurate,  41 
Movement  of  teeth  in  phalanx,  9 

Xaso-labial  folds,  2 
Neutroclusion,  13 
Nomenclature,  i 
Normal  occlusion,  3,  18 

Occipital  anchorage,  9 

Occlusal  relations,  15,  18 

of  the  temporary  teeth,  15 
of  the  permanent  teeth,  18 

Occlusion,  7,  14 


INDEX 


lO: 


Open-bite  maloclusion,  3 
Orthodontia,  i 
Orthodontics,  i 
Orthopedia,  i 

dental,  i 

dento-facial,  2 

Physiology  of  tooth  movement,  8 
Premature  loss  of  deciduous  teeth,  21, 
Preservative  forces  of  arch  integrity 

10 
Prognathism,  6 
Prolonged     retention    of     deciduous 

teeth,  21 
Protrusion,  5 

Re-alignment,  60 
Reciprocal  anchorage,  1 1 
Regional  development,  10 
Regulating  appliances,  10 
Reinforced  anchorage,  1 1 
Removal  of  bands,  78 
Results  of  treatment,  60 
Retention,  77 

appliances,  87 

bands,  86 
Retracting  screw,  10 
Retrusion,  5 
Rotate,  4 


Saddle-shaped  arch,  8 
Secondary  anchorage,  9 
Separating  teeth,  method  of,  47 
Short-bite  malocclusion,  3 
Simple  anchorage,  9 
Soldering,  48 

hard,  80 

soft,  48 
Stationary  anchorage,  9 
Supra-occlusion,  6 
Supraversion,  12 

Technic  course,  78 
Terminology,  i 

Time  required  for  retention,  77 
Tooth  movement,  physiology  of. 
Torso-occlusion,  8 
Torsoversion,  12 
Transversion,  12 
Treatment  of  cases,  63 

Unilateral,  5 
Unimaxillary,  5 

Value  of  good  models,  41 

Zone,  4 

dental,  4 


Dl'7 


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